Virginia Commonwealth University VCU Scholars Compass Theses and Dissertations Graduate School 2014 Transitioning from a Traditional Nursing Home Environment to Green House Homes: What are Stakeholders' Attitudes Toward and Satisfaction With the Small House Care Environment Christine Harrop-Stein Virginia Commonwealth University Follow this and additional works at: https://scholarscompass.vcu.edu/etd Part of the Medicine and Health Sciences Commons © The Author Downloaded from https://scholarscompass.vcu.edu/etd/3531 This Dissertation is brought to you for free and open access by the Graduate School at VCU Scholars Compass. It has been accepted for inclusion in Theses and Dissertations by an authorized administrator of VCU Scholars Compass. For more information, please contact [email protected]. TRANSITIONING FROM A TRADITIONAL NURSING HOME ENVIRONMENT TO GREEN HOUSE HOMES: WHAT ARE STAKEHOLDERS’ ATTITUDES TOWARD AND SATISFACTION WITH THE SMALL HOUSE CARE ENVIRONMENT? A dissertation in partial fulfillment of the requirements for the degree of Doctor of Philosophy at Virginia Commonwealth University By Christine A. Harrop-Stein Master of Science in Health Education, St. Joseph’s University, 1994 Bachelor of Arts in Psychology, La Salle University, 1987 Co-Director: J. James Cotter, PhD Professor, Department of Gerontology Co-Director: E. Ayn Welleford, PhD Professor, Department of Gerontology Virginia Commonwealth University Richmond, VA August, 2014 ii Acknowledgements This dissertation is dedicated to my husband and best friend, Jonathan, and to our two beautiful daughters, Hannah and Abby. Without their love, humor, and encouragement, achieving this Ph.D. would have been impossible. This dissertation is also dedicated to the memory of my dear grandmother, Lois Rexroat Riley, who died during the first semester of my Ph.D. journey. Her memory inspired me to “keep calm and carry on.” During the past five years, I had tremendous support from family and friends who provided childcare, encouragement, and good wine. I am grateful for all that they have done for me. It truly takes a village to earn a PhD. I would like to thank Drs. J. James Cotter and E. Ayn Welleford, my committee co- chairs, for taking a chance on me and daring me to achieve far beyond my expectations. My committee members, Drs. Diane Dodd-McCue, Katie Ehlman, and Mary Ligon, shared their wisdom and talents, and gave generously of their time, for which I am truly grateful. “It is all your fault,” Dr. Ligon. I would like to extend a very special thank you to Melissa Fortner, the residents, and the staff members of Virginia Mennonite Retirement Community for welcoming me into their home and work place and generously sharing their time and insights with me. iii Table of Contents Table of Contents ........................................................................................................................ iii List of Tables .............................................................................................................................. xi List of Figures ........................................................................................................................... xiii Abstract ..................................................................................................................................... xiv Chapter One: Introduction ............................................................................................................1 Background .......................................................................................................................3 Statement of the Problem and Significance ......................................................................7 Purpose of the Study .........................................................................................................9 Theoretical Framework .....................................................................................................9 Research Questions .........................................................................................................10 Analytical Strategies .......................................................................................................11 Scope of the Study ..........................................................................................................11 Overview of Remaining Chapters ...................................................................................11 Chapter 2: Literature Review ......................................................................................................12 Culture Change Care Philosophies .................................................................................12 Overview .........................................................................................................................16 The History of Institutional Elder Care ..........................................................................17 Evolution of Elder Care ..................................................................................................25 iv The Medical Model of Care ............................................................................................26 Contemporary Nursing Home Residents: Who Are They? ............................................29 Nursing Home Culture Change .......................................................................................29 Nursing homes as organizations and organizational culture. ..............................30 Organizational change. .......................................................................................31 Nursing home culture change .............................................................................34 Person-centered care ...........................................................................................36 Nursing Home Culture Change Outcomes .....................................................................39 Green House Project .......................................................................................................44 Stakeholder Attitudes Toward and Expectations for Culture Change and Person-Centered Care ...................................................................................50 Summary .........................................................................................................................51 Barriers to Culture Change .............................................................................................52 Future of the Culture Change Movement .......................................................................54 Measuring Nursing Home Culture Change & Person-Centered Care ............................55 Chapter Two Summary ...................................................................................................62 Chapter 3: Research Methods .....................................................................................................64 Overview of Research Design and Methodology ...........................................................64 Background .....................................................................................................................65 Qualitative Study Design & Rationale ............................................................................66 Study design rational and operational definition of symbolic interactionism and grounded theory ...........................................................................................66 Symbolic Interactionism (SI)...................................................................67 v Grounded Theory (GI) Methodology ......................................................68 Sampling Procedures ......................................................................................................69 Sample.................................................................................................................69 Sample inclusion criteria.....................................................................................70 Measurements .....................................................................................................70 Variables of interest. ...........................................................................................71 Analytical strategies specific to Grounded Theory .............................................71 Data management and analysis ..............................................................71 Building and refining theories ................................................................74 Trustworthiness criteria ......................................................................................74 Threats to trustworthiness ...................................................................................77 Procedures Related to the Focus Groups ........................................................................82 Staffing ................................................................................................................82 Location and timing of focus groups ..................................................................82 Transcripts...........................................................................................................83 Confidentiality ....................................................................................................83 Summary .........................................................................................................................83 Quantitative Study