An Interview with the developers, Karen Schoeneman and Carmen Bowman
Karen, can you tell us how the Artifacts of Culture Change came to be?
Karen: As a founder of the culture change movement and Pioneer Network, I developed a keen interest in the many wonderful changes nursing homes were making to their homes. I was working then at the Centers for Medicare and Medicaid Services (CMS) in the Division of Nursing Homes, as the lead in Quality of Life and co-lead for the survey process and surveyor training. This was after 17 years working in social services for long-term care providers that were cold institutional settings, nothing like home.
The pioneering nursing home providers were turning their enthusiasm for the principles of culture change into real and concrete changes that were designed to get rid of institutional practices and turn their places into something as close as possible to home.
I began attending Pioneer Network conferences when they began in 1999, and I would sometimes couple my attendance with a visit to an innovative culture changing provider nearby. Often Carmen Bowman partnered with me, in attending and sometimes doing presentations at conferences, as well as renting a car to visit culture changing nursing homes to see what they were doing. It occurred to both of us that there was no guidance available for what specific changes would be good for nursing homes and other long-term care providers to make. Therefore, I developed a CMS contract for Carmen to work with me to turn information we had collected into a questionnaire tool that homes could use to see the variety of things that were successfully getting changed, so they would be able to review their own practices and choose practices to change. This was the original Artifacts of Culture Change, released by CMS in 2006.
Carmen, what did working on the Artifacts tool mean to you?
Carmen: Getting to work as a subcontractor to the CMS Division of Nursing Homes and with Karen Schoeneman, former Deputy Director there, has been a highlight of my life. In fact, after I gave birth to our only child, Ellie, in March of 2005, I would work on the draft when up in the middle of the night with her, and then CMS released the original Artifacts tool in April of 2006 which felt much like another birth of a sort.
Getting to debut the Artifacts of Culture Change at an invitation-only event at CMS in Baltimore was a pivotal moment in the culture change movement. Not only did we hope Artifacts would provide measurement, which is always desired in this field, we also hoped it would provide education which it did. We still hear that it does to this day, and we are glad.
Creating this tool, having the opportunity to expand and revise it as well as design the first-ever tool for assisted living, has been truly a labor of love.
How about you, Karen?
Karen: The development of this major 2.0 expansion of the Artifacts tool, plus developing a special version for assisted living, has been a dream come true for me. It encompasses many more things that innovators have successfully changed over the years since the original was released, and it forms an up-to-date tool for these settings to use to make splendid changes to create home after COVID has highlighted how important quality of life is to residents and families.
Carmen, How is the 2.0 version different from the original tool?
Carmen: The 2.0 version is not really an update, it is an expanded version adding the many culture change practices that were not in the first version. The original tool included 69 culture change practices (plus 10 outcome items). Artifacts (ACC) 2.0 includes 134 practices and ACC-AL includes 132 practices. (no outcome section this time). A new feature leaves the arbitrary point structure in favor of simply indicating for each practice whether it is fully, partially or not implemented. We hope this will create ease of completion giving way for more precious time to decide and plan practices the community desires to work on implementing.
Karen, What do you and Carmen hope nursing homes and assisted living communities will do with the tool?
Karen: We hope that they will use a team approach to completing the tool, with the administrator, representatives from each department, supervisory and non-supervisory staff, CNAs, residents and family members discussing the items and completing the tool together. As they work through the tool, we hope that they will celebrate the practices that are already doing and, get ideas as to other practices that they might want to work on, and make a plan for implementing those practices. We’d like them to consider the good work that their community can do to implement the many culture change practices represented that they may not have… yet.