Culture Change Now! is Action Pact's periodical for long term care professionals interested in Culture Change. It is filled with how-to information and articles of inspiration. All levels of staff and families will will enjoy the only publication solely dedicated to culture change!

At the wilderness edge 50 miles south of the Canadian border, Northern Pines Communities (a.k.a. Northern Itasca Health Care Center) has transformed life for its residents and staff and realized a new vision for long-term care.

"When I open my blinds a certain way, it reminds me of a New England fishing village," says Mrs. I., a resident at this 40-bed nursing home in Big Fork, MN (pop. 350).

Before the home's transformation from a medical to a social model of care, Mrs. I refused to eat and had to be fed from a tube. But after she moved with her new cat into a new room filled with personal mementos and a view of the deer feeding station, her interest in life rekindled. She gained weight, going from 90 to 105 pounds in seven months.

"Actual outcomes far exceeded expected outcomes," writes former Administrator Linda Bump, who helped initiate and oversee Northern Pines' culture change journey.

"Initial fear of compromising clinical quality of care... was immediately dispelled... Nurses concerned with med passes by cross trained staff... were reassured by medication error rate reduction from nearly 5% in the traditional model to less than 0.5% less than one year later..."

"All traditional measures of satisfaction with assistance, food, activities and the environment either maintained their high ranking or moved in a positive direction... except satisfaction with sharing a room, which plummeted to a new low as awareness of the potential for privacy in the nursing home increased..."

"Overall ranking of job satisfaction increased by 19%... turnover declined from 52% to 13%. Retention was 100% for RNs during the final year of implementation and the first year of working in communities..."

The vision for how to turn the 28 year-old building into a real home for residents was shaped by bus trips to nearly two dozen facilities in North Dakota, Wisconsin and Minnesota. They visited the Swedish Service House at Lyngblomsten in St. Paul, and others - like the Wilder Residence in St. Paul and Lakewood in Milwaukee - that had been influenced by Providence Mount St. Vincent in Seattle, the Eden Alternative, Wellspring Innovative Solutions and the Live Oak Project of California.

"Following these true pioneers [we] transitioned a traditional hospital-attached, medical model nursing home to a wonderful new world of person-centered high quality medical and personal care in a home-like setting."

Physical renovation added 6,500 square feet to the building, enabling Northern Pines to add 14 private rooms and more common areas while still maintaining just 40 beds. The resident population was divided into three small "communities" of 10-16 residents each.

"Self directed work teams gave all employees a strong voice in shaping and implementing the care delivery system in the communities. Department heads were eliminated and the organizational chart flattened to spread the leadership into the communities and closer to the residents. Employees are cross-trained so that each is now a C.N.A. and everything is everybody's job, just like at home..."

"With utmost respect for the regulatory mandate of OBRA, without waivers, within the traditional long-term care reimbursement system and within the historical staffing pattern, Northern Pines Communities made the vision real for everyone involved in the project."