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Renovating skilled nursing facilities: Adjusting the property and upgrading the culture

July 18, 2012
by Miles Girouard, LEED AP and Amy Ruedinger, RN RAC-CT
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Successfully implementing cultural change in a skilled nursing facility begins with visionary leaders who recognize the inherent link between physical environment and the delivery of person-centered care. Even the most impressive and creative renovation will fail to make a significant positive impact on resident care if a similar adjustment in mindset doesn’t take hold within the culture. If you change the facility without changing the ethos, your residents will be missing out on the benefits and value both can provide together.

Many skilled nursing facilities are making the switch from a medical model to the person-centered model that is so highly desired by residents and their families. But, in order to successfully accomplish this shift, a leader’s vision must include both facility adjustments and internal process revisions that focus on new practices in resident care delivery. Let’s explore how to create an environment that promotes and sustains resident autonomy, individualized care and positive outcomes.


Every seasoned leader knows that guiding change is a challenge that takes careful consideration--and renovating a facility and culture is no different.

It is important for staff to understand the vision for the changes and why person-centered care is so important. It is vital they grasp the benefits residents will receive and how that impacts the sustainability of the business and their careers. As the specific adjustments are being considered, it is essential to get the input and buy-in of staff, management, residents and families. If the changes that are being made are not workable and efficient for staff, they’ll revert back to their old ways and derail the values that are being pursued. For example, one renovation that we helped design included a significant change in the nurses’ station, making it more discreet. However, buy-in had not been achieved and training had not been effective. A year later, a de facto nursing station (and eyesore) had been created.

In our experience, we’ve found six elements critical in successful facility and cultural renovations: 

  1. The effort has strong buy-in at the top. Senior leaders support the initiative and understand both the costs and benefits. Executives lead by example through day-to-day behaviors and decisions.
  2. All employees are centered on common values. Employees have a clear understanding of where they are in strategic terms–-and where they want to be. They have defined a model, complete with clear strategies for how to close any gaps. All divisions, teams and individuals know their parts and feel committed to the desired results.
  3. Change initiatives are team-driven. Team building reinforces individual development and produces real change in the culture.When a group of people starts functioning more effectively, change momentum is underway and the odds for success are improved.
  4. Skills-based training is provided. As part of the new employee orientation process, new staff members receive both skills-based training and a clear description of the vision and mission. Employee training ensures concepts and language are understood by everyone. Cross-training creates support for change by providing skills that allow people to contribute and “challenge up.”
  5. Initiatives are measured. Successful change initiatives use clearly defined metrics with which to gauge the degree of success. Accountability is present to ensure that proper measures are taken to effect necessary changes.
  6. Management sticks to the plan. Successful change initiatives take time to be fully enacted. Research shows it can often take at least three years for change to take root fully and to demonstrate a sustainable cultural shift. Be persistent, but patient.


As you seek to adjust your culture to be more person-centered, be certain that the physical adjustments you implement will make a true impact. On a recent visit to a renovated facility, we saw a resident enjoying a newly created place to rest on a previously long, uninterrupted corridor. This change made a difference in her quality of life. Understanding what changes residents want and need, and creating space that accommodates those needs, is pivotal.

Enhancing the entrance sets the stage for people’s interaction on and expectation of your property. Is it inviting?  Does it make everyone feel welcome? Entrance canopies can provide for covered loading and unloading in any type of weather. Power-assisted entrances are friendly to all levels of mobility. To complete the new mindset, be sure to designate a receptionist or greeter to ensure a friendly face is ready for every engagement.

Corridors provide great opportunities to freshen up a facility and provide a more person-centered experience. Installing handrails on both sides and providing resting spots in long corridors gives assistance to those in need. Making sure the rails are ergonomic and attractive will make them a valued resource to residents and help enhance the visual appearance of the hallway.Installing corner guards and maintaining the finishes can prevent unsightly wear from walkers and wheelchairs. Age-appropriate artwork and seasonal decorations often are appreciated additions that stimulate conversation and memory in these settings.