Culture changes for Kansas nursing homes

peakBy Kansas Department for Aging and Disability Services

TOPEKA – In 2002, the Kansas Department for Aging and Disability Services (KDADS) became a national leader in the push to bring about “culture change” in nursing home facilities across the State of Kansas by developing a now popular and on-going initiative known as “Promoting Excellent Alternatives in Kansas Nursing Homes (PEAK)”.

Traditionally, high-quality care is seen as the gold standard for high-quality nursing homes. But Kansas has been a pioneer in raising the bar, changing that standard to include quality of life as an element equally important in assessing a facility’s success.

In 2011, KDADS introduced an even more progressive model, PEAK 2.0. Building on the success of the original PEAK, providers, consumers and advocates developed a pay-for-performance incentive program, under which nursing homes can be placed in one of five incentive levels to track how they are pursuing culture change, that they met minimum competencies in providing person-centered care and have sustained person-centered care, and that they are using their experience to mentor other facilities in providing person-centered care. Attainment of each level is tied to an incentive payment through Medicaid reimbursement to encourage more nursing homes to move towards person-centered care.

“More than 160 nursing homes in Kansas have demonstrated their commitment to excellence and to person-centered care, making life rewarding and enjoyable for their residents through this PEAK 2.0 program,” KDADS Secretary Shawn Sullivan. “We are eager to expand that spirit to all the nursing facilities in our state. Improving the quality of life enjoyed by nursing home residents is a significant—and measurable—priority. Person-centered care should be the standard of care for all Kansas nursing home residents instead of an institutional and medical based model.”

Since the beginning, the PEAK program has two goals. The first is to recognize those Kansas nursing homes that pursue progressive models of care, the second to provide education to nursing home providers about how to implement change and document its value.

KDADS contracted with the Kansas State University (KSU) Center on Aging in 2012 to administer the program and work toward achieving those goals. KDADS continues to oversee the program and apply the incentive to Medicaid reimbursements, but KSU handles administrative functions such as application, training and evaluation.

Today, KDADS has 162 active participants in the PEAK 2.0 program and continues to move toward statewide changes that refocus caregiving from the institutional model of accomplishing tasks to emphasizing the person — person-centered care. To achieve these changes, nursing homes have begun to shift from solely providing the services and supports that their residents need to concentrate on four area essential to creating a person-centered care environment:

· Resident Choice – This involves guiding organizations away from the regimented top-down practices of the traditional model to a new approach based on personalized care/service plans, resident input and actively engaged families. It emphasizes customer service, hospitality and attentiveness to individual needs. Providing and promoting choices to residents is the most essential principle of resident-centered care. It provides resident with real choices across the board in their day-to-day living, relationships, activities, learning, leisure, and end-of-life.

· Staff Empowerment – This embraces the empowerment of staff to successfully function in many different roles and make decisions and respond to the choices of residents by building a relationship with them. KDADS has seen this increase job satisfaction for employees and quality of care for resident. Staff is given the latitude and authority, necessary training and flexibility to respond to the needs of the residents they serve. Staff have input into their work schedules and assignments, and are encouraged to work together as teams to innovate and solve problems.

· Home Environment – In this area the goal is for nursing homes to adopt a person-centered approach that shapes the physical environment, organizational structure and interpersonal relationships in ways that create a genuine atmosphere of home. It provides residents with clear opportunities to direct their own lives. Physical environments should be more homelike and less institutional. Larger nursing units are replaced with smaller “households” of 10 to 15 residents, residents would have access to beverages and snacks 24/7 just like they would at home, and overhead public address systems would be eliminated to create a homelike environment.

· Meaningful Life – Staff who work in nursing homes shape the physical environment, organizational structure, and interpersonal relationships with residents in ways that create an atmosphere of home. This includes building on lifelong interests and offering new activities/experiences for residents.

Educational objective modules of the PEAK program were researched and designed by staff at the in KSU Center on Aging and have been distributed to all Kanas nursing homes and other advocates in the profession. They are also available at the KDADS website at

Applications for the PEAK 2.0 program are now being accepted through April 30, 2014 for any Kansas long-term care provider that wishes to participate. To apply, visit http://www/ and click on the APPLY NOW link. 

If you have questions about the program, contact the PEAK 2.0 team at (785) 532-2776 or