Improving Quality of Life for Nursing Home Residents Through a Culture Change Initiative

Altarum is evaluating a culture change initiative in six nursing homes in Michigan. 

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Altarum is evaluating a culture change initiative in six nursing homes in Michigan. The project aims to improve quality of life for residents of the nursing homes by improving the skills of staff and operational practices and protocols of the participating homes. The project is funded by the Michigan Department of Health and Human Services with Civil Monetary Penalty funds.

Our Approach

Altarum is assessing the impact and sustainability of comprehensive culture change training and education in a variety of nursing homes by monitoring selected clinical quality measures; analyzing quality-of-life reports from residents, family members and staff; tracking shifts in operations (such as more dining flexibility); and assessing the economic impact.

The Eden AlternativeĀ®, a global non-profit organization dedicated to creating quality of life for elders and their care partners, is providing education and coaching to the nursing homes. The training is designed to empower nursing home administrators and all other staff to understand how daily practices and protocols can be shifted from rigid, institutional patterns of service delivery to care that is more individually tailored to the individual needs and preferences of elderly residents.


The project is in its second year, and we expect to have preliminary findings to share later this year. Our hope is to use learnings from Michigan to inform and replicate similar comprehensive culture change initiatives in other states.

Improving Quality of Life for Nursing Home Residents Through a Culture Change Initiative Contact

Contact Us

Krissy Azeem

Krissy Azeem  - MPH, PMP

Senior Director, Delivery Systems Transformation 

Areas of Expertise
  • Medicaid
  • Training and Technical Assistance
  • Long-Term Services and Supports

A leader in innovating the care delivery system with health plan, state, and federal partners, Krissy is proficient in health policy implementation and analysis, with a focus on home and community-based waivers and long-term services and supports. She has an eye for identifying the unintended consequences of proposed policies and creating innovative, and realistic, recommendations for state partners. Krissy has deep experience in providing technical assistance, designing and implementing action-oriented and outcomes-based learning systems, and catalyzing behavior change through thoughtful and strategic training. Passionate about improving the care delivery system, she has supported states and communities in enhancing the infrastructure, training, and experiences for direct service workers, including those who self-direct. Krissy holds a Master of Public Health degree from The George Washington University School of Public Health and Health Sciences. 

Christine Stanik

Christine Stanik  - PhD

Program Director, Delivery System Transformation

Areas of Expertise
  • Mixed-Methods Research 
  • Care of Older Adults
  • Evaluation of Systems Level Interventions

As a psychologist, Christine brings a research and evaluation perspective to improving care services for elders and the disabled at a systems level. Through the design and execution of unique research protocols and tools, she works to build an evidence base for best practices around quality-of-life improvement and the person-centered care model. Using insights gained through empirical methods, she advocates for PACE expansion and comprehensive culture change in nursing homes.