Refining Culture Change in Long-Term Care: Embracing a Stakeholder-Inclusive Approach

Anna R. Franklin

NCCCC Member, Regional Ombudsman

Southwestern Commission AAA, Region A

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For decades, the long-term care (LTC) industry has evolved from an institutional model prioritizing efficiency and compliance to a movement known as "culture change" - an approach that emphasizes person-centered care, dignity, and quality of life. As this movement grows, so does the conversation around how we define and engage with those who influence and are influenced by the LTC system.

The stakeholders of culture change include those who have a vested interest in the well-being, operations, and outcomes of the LTC environment, including residents, staff, advocates, families, and community partners like you.

Understanding the Complexity of LTC Financing and Governance

The structure of long-term care facilities varies widely. Recent shifts in financing models, such as the rise of private equity ownership and increased debt leverage, have changed how homes operate. These financial dynamics can constrain a facility's flexibility to implement person-centered care initiatives. While some shareholders and owners are committed to long-term investment and quality, others may prioritize short-term returns, affecting the ability to sustain responsive care models.

This distinction is essential in understanding how resource allocation, staffing models, and culture change practices are shaped not only by management philosophy but also by financial pressures. For example, while understaffing is often viewed through the lens of cost control, it is also closely tied to turnover and recruitment challenges, which can increase operational costs through reliance on agency staff.

Leaders in a conscious corporate culture should incorporate essential values such as integrity, trust, a customer-first approach, resident-centered care, staffing support, and

robust corporate governance into their financial strategies.

Corporate governance is not just about rules and compliance.

Expanding the Culture Change Model to Include All Stakeholders

A refined culture change model must acknowledge the interconnected roles of all stakeholders:

• Residents – Central to all efforts; their dignity, autonomy, and voice must remain paramount.

• Staff and Leadership – Professionals who carry out care daily and shape workplace culture.

• Families and Advocates – Partners in care who offer accountability and insight.

• Owners and Shareholders – Investors with the capacity to enable or constrain progress.

• Community and Service Partners – Those providing support services and fostering community inclusion.

• Regulatory and Oversight Bodies – Entities that promote accountability and compliance.

Recognizing all of these as essential stakeholders re-orients the conversation from opposition to collaboration, and from rigidity to responsiveness.

Benefits of a Stakeholder-Inclusive Culture Change Approach

• Resident Empowerment: Environments that promote choice, engagement, and well-being.

• Staff Support: Reduced burnout and improved retention through inclusive leadership.

• Community Partnership: Stronger relationships with families, local organizations, and service providers.

• Sustainable Investment: Owners and shareholders committed to long-term quality care.

• Improved Outcomes: Better compliance, ethical standards, and satisfaction for all involved.

How NCCCC Supports Refining Culture Change

The North Carolina Culture Change Coalition (NCCCC) is committed to supporting all who live, work in, and operate long-term care homes. Through education, collaboration, and innovation, NCCCC encourages improvements that go beyond minimum regulations to foster inclusive, warm environments that feel like home. NCCCC’s renewed focus is on offering relevant, responsive education to support this shift. The Coalition is developing a fresh series of training sessions based on feedback from LTC facilities. A survey will be sent out in the near future to nursing home providers to assess the needs of long-term care community staff and what information and education they feel is needed to provide enhancements that bring joy and meaning to LTC environments, for residents and staff alike.

Conclusion: Collaborating for a Compassionate Future in LTC

Culture change is not a matter of replacing one model with another but of refining our understanding of how long-term care systems can best serve their communities. A stakeholder-inclusive approach integrates the roles of industry stakeholders alongside those of caregivers, residents, advocates, and families.

The NCCCC believes in a future where all voices—regardless of role or relationship—are acknowledged and valued in shaping care. Through continued advocacy, collaboration, and education, we move closer to long-term care environments that are compassionate, inclusive, and sustainable.

People, not just profits, must remain at the heart of care.