“We talk a lot now, which we didn’t use to do before,” she said. “We were close before, but now we’re closer, because now you have a set of residents who you go to see all the time.”

But it’s not just nursing homes and their staff that need to change, McLaughlin and others said. The regulatory and inspection system also creates hurdles.

McLaughlin said nursing home administrators are afraid to loosen their rules because they fear they may have worse medical outcomes and be penalized for it.

In reality, she said, culture change can improve outcomes. But the nursing home survey (inspection) system does follow strict federal and state laws and regulations that can be interpreted to discourage or forbid some of the newer practices, so Quality Partners recently did a presentation to clarify these issues for surveyors nationwide, sponsored by CMS.

“Here in Rhode Island, our survey folks have been genuinely fabulous, and came for training session so they could understand our work,” she said. In addition, Gifford said, the state has received for a grant to review the guidelines that surveyors follow, “to see if the way we’ve interpreted the regulations has created a barrier to adopting culture change.”