The Nursing Home Reform Act of 1987 established quality standards for nursing homes nationwide that emphasized the importance of quality of life and residents' rights. Quality of life is perceived by residents partly as a product of their health, social supports, and environment and is related to their sense of well-being, level of satisfaction with life, self-worth and self-esteem. Policies, practices and operations of a facility have a direct impact on residents' quality of life; while the care model has an indirect effect - through the approach of inclusion of family and community in daily life (Kane, 2003)
Culture change began as a movement to change long-term care from an institutional model of care toward one that is residential in scale and person-centered. The culture change movement began promoting programs in an effort to deinstitutionalize long-term care and is rapidly being adopted into every level of the continuum of care. The continuum of care includes independent living settings, adult day (health) care, assisted living facilities, nursing homes and hospice settings. Over the past two decades state regulators, advocacy groups and providers have introduced the concepts of culture change into the continuum of care - including but not limited to The Eden Alternative, Wellspring, Planetree, The Green House Project, and other types of small house, household and neighborhood models.
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