The Kansas Department on Aging (KDOA) is committed to ensuring high quality services for Kansas nursing home residents.   For the past ten years, KDOA has been recognizing nursing homes for successfully implementing culture change through the Promoting Excellent Alternatives in Kansas Nursing Homes program commonly known as PEAK.  Although the phrase “culture change” may have different meanings, it gave rise to new ideas on how the focus of care could be changed from the type of services provided to the person receiving those services.  As a result, the personal preference of residents has become as important as providing the services and supports they need.

From the beginning of PEAK, KDOA pursued two primary goals.  First, the agency presented annual awards to homes which accomplished significant culture change.  Second, KDOA worked to educate others about the culture change movement and the accomplishments being made in Kansas.

Through the PEAK awards program, KDOA has recognized 51 different providers for their efforts to adopt culture change.  The awards program continues to recognize homes for significant improvements in the areas of resident choice, staff empowerment, environment, and meaningful life.

Building on the successful history of PEAK, the agency is moving in expanded directions.  KDOA will continue to recognize homes for their accomplishments with culture change.  However, with publication of the new PEAK Resource Guide, the generic phrase of “culture change” has been replaced by the more understandable phrase of “person-centered care.”  The latter better describes the kind of care KDOA wants to encourage.

Finally, KDOA recognizes that developing person-centered care in all nursing homes will not happen overnight.  Therefore, to quicken the pace of adoption, the agency has redesigned the pay-for-performance incentives included in the Medicaid nursing facility reimbursement methodology.

Facilities must submit an application for consideration for a PEAK 2.0 Award. Criteria for each award category is outlined in the PEAK 2.0 Resource Kit.  Finalists will be visited by a panel of professionals before awards are determined. Award-winning nursing homes will be recognized with a signed Governor's Proclamation declaring “PEAK Week” and a plaque that will be presented by the Secretary of Aging.  

Application materials and instructions for the 2012 PEAK Awards are available below. The deadline for registration and applications is February 14, 2012, the entire narrative and action plan are due by April 15, 2012. More information about the PEAK application process is available in this PEAK 2.0 Application Information sheet.

PEAK Registration (PDF)

Kansas Culture Change Instrument (PDF)

Culture Change Educational Modules
In order to meet the educational objectives of PEAK, KDOA contracted with KSU to produce educational materials to assist nursing homes.  KSU has produced a booklet entitled “Pioneering Change in Kansas Nursing Homes.”  This book has been distributed to all Kansas nursing homes and other parties involved in the nursing home profession and can be viewed at KSU’s website at www.k-state.edu/peak/.  In addition, KSU staff have developed the following training modules, also available on their website:

Activities Part 1 Part 2 Community Creating Home Part 1 Part 2 Culture Change Part 1 Part 2 Dementia Dining Part 1 Part 2

Diversity End-of-Life Family and Community Leadership Measuring Change Resident Spiritual Needs Returning Control to Residents Sexuality Spirituality Staff Part 1 Part 2

These modules were researched and written by staff in the Kansas State University Center on Aging as a part of the PEAK project. Updates to these modules will be available in the future through the Center on Aging. KSU staff are available for consultation and other services related to culture change in nursing homes. Contact the Center on Aging at 785-532-5945 or gerontology@k-state.edu for information on the module updates and/or the fee schedule for consultation and other services.

KDOA would like to thank the many sponsors and organizations that have supported this initiative, including the PEAK Advisory Board. Members include the following organizations:

• LeadingAge Kansas
• Kansas Health Care Association (KHCA)
• Kansas Hospital Association (KHA)
• Kansas Adult Care Executives (KACE)
• Kansas Advocates for Better Care (KABC)
• Kansas Foundation for Medical Care (KFMC)

Culture Change Outcomes
A study was completed comparing PEAK nursing home winners from 2002 – 2005 to non-PEAK nursing homes using the Nursing Facility Quality and Efficiency Outcome Incentive Factor as the measurement. The quality/efficiency factor is a component of the Kansas Medicaid nursing home rate-setting methodology that was implemented July 1, 2005, to provide a monetary incentive for favorable outcomes in the following areas: direct care staffing; operating costs; direct care staff turnover; staff retention; total occupancy; Medicaid occupancy; and Medicaid certification survey results.

Results of the study proved promising. Overall, a higher percentage of PEAK homes (63%) received an incentive factor ranging from $1 to $3 per resident day, compared to 36% of non-PEAK homes. To read the complete case study.

Future Activities
The PEAK initiative should prove to be even more exciting in the coming year.  KDOA continues its contract with the Kansas State University’s (KSU) Center on Aging to develop training materials and provide assistance to nursing home providers transitioning to person-centered care.  KSU will use the information received in this year’s PEAK applications as a basis for educational materials, and as inspiration for other homes to embrace change.  KSU will continue developing the education modules and culture change newsletters. KSU also coordinated five regional culture change symposia in 2007 for Kansas nursing home staff and other interested stakeholders. A total of 369 individuals representing 74 Kansas nursing homes attended these symposia and evaluations were encouraging.

A grant issued to Meadowlark Hills provided partial funding for the development of a “Deep Culture Change Model” toolkit, which was released in 2006 and is now available through LeadingAge Kansas or Kansas Health Care Association (KHCA).  Proceeds from the sale of this toolkit will be used to further promote culture change in Kansas.

KDOA has contracted with Kansas University Medical Center (KUMC) to develop a tool that will accurately measure culture change and then determine the impact culture change has on the quality of care.  KUMC determined in a previous study that low turnover correlates directly with higher quality of care.  It is believed that nursing homes that have adopted culture change will have lower turnover and, hence, better care.  In addition, there are other quality measures that will be compared in this study to further determine the impact of culture change on nursing home residents’ quality of care.

KDOA continues to support the Kansas Culture Change Coalition, with the PEAK Initiative providing a part of the overall culture change activities.

For more information on the PEAK initiative, contact Rhonda Boose at (785) 368-6685 or by email at Rhonda.boose@aging.ks.gov.