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North Carolina Support for Culture Change

Survey Agency

The North Carolina Coalition for Long Term Care Enhancement (NCCLTCE) grew out of the North Carolina Eden Alternative Coalition, which formed in 1996 to advocate for change in the state's nursing homes. From its inception, the Coalition represented both the state agency and reformers' interests in moving long-term care toward more home-like environments. A staff person from the state agency serves as the "Coalition Secretary" and the agency absorbs all of the costs of publishing the coalition's quarterly newsletter which is sent to all skilled nursing facilities in the state and is posted on the agency's website.

NCCLTCE, the nation's oldest state-based culture change coalition, has held 2 statewide conferences as well as several town hall meetings. Known principally for its award-winning Environmental Enhancement Grant Program, the Coalition uses CMP monies to assist skilled nursing homes transform their cultures of care. To date, this program has distributed almost $1 million to help move more than fifty homes along their unique enhancement journeys. 

Department of Health and Human Services

The NC Department of Health and Human Services and the UNC Institute on Aging partner for the WIN A STEP UP program. WIN A STEP UP stands for Workforce Improvement for Nursing Assistants: Supporting Training, Education, and Payment for Upgrading Performance. For the last 6 years, North Carolina DHHS has partnered with the UNC Institute on Aging, to develop and conduct WIN A STEP UP, a successful program that directly attacks the problem of turnover using funds from federal civil monetary penalties. WIN A STEP UP is a proven program that upgrades the skills of nursing assistants, increases their career commitment, and provides rewards and recognition. Learn more about the program at UNC Institute on Aging WIN A STEP UP program.

Care Ombudsman Program

The state long-term care ombudsman program began its involvement with culture change through the N.C. Eden Coalition in 1998. The Ombudsman Program staff continue to be active members of the current state culture change coalition, "North Carolina Coalition for Long-Term Care Enhancement". Program staff attended the first Quality Improvement Organization (QIO) meeting in 2004 to promote the Person Centered Care Collaborative pilot and the final Quality Improvement Organization learning session in 2005 when nursing homes across the state presented results of the pilot. The state LTCOP staff reported to the Regional Ombudsmen at a statewide training about what nursing homes are doing regarding culture change in their facilities. Denise Rogers, LTC Ombudsman/Elder Rights Specialist, attended the St. Louis Accord in June 2005 as a stakeholder for North Carolina. LTCOP staff also had the opportunity to give feedback on the rough edit of the "Almost Home" video and promoted the video statewide through the Regional LTC Ombudsmen. In 2006, the N.C. QIO staff attended the State LTC Ombudsman quarterly training and updated the Regional Ombudsmen on the Person Centered Care Collaborative. At the local level, Regional LTC Ombudsmen continue to be actively involved in promoting culture change in facilities. A few examples of their involvement include: 
  • Holding a monthly "Culture Change Initiatives Roundtable" lunch for facility administrators. 
  • Encouraging the Nursing Home Community Advisory Committee volunteers to notice any culture change activities and share ideas with administrators seen in other facilities. 
  • An annual conference, with approximately 800 people in attendance, featuring John George the nursing home administrator in the "Almost Home" video.