Our Commitment to Culture Change

A Gold Standard

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 toward person-centered care.

“More than 215 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 Tim Keck said.

“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 emphasized 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, while 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 care-giving from the institutional model of accomplishing tasks to emphasizing the person in person-centered care. To achieve these changes, nursing homes have begun to shift from solely providing the services and supports their residents need to concentrating on four areas essential to creating a person-centered care environment:

  • Resident Choice – 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 – 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 residents. 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 have access to beverages and snacks around-the-clock just like they would at home and overhead public address systems are 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.

PEAK Facility Successes

The successes of the PEAK program are many. Two nursing homes in Kansas share their successful journey:

  • Wheat State Manor, Whitewater

  • Kansas Christian Home, Newton

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