If the U.S. nursing home system hopes to remain a viable long-term care option, then the industry must reevaluate how its facilities are designed and managed, report health care analysts at the Commonwealth Fund.

Despite the Nursing Home Reform Act of 1987, which established residents' rights and quality standards for the industry, few nursing homes have fully adopted best practices around resident-centered care, according to a survey by the New York-based health policy group.

Between February and June of 2007, the Commonwealth Fund polled 1,435 nursing homes to measure the extent in which institutions are adopting the philosophy of "culture change." That is creating an environment where seniors enjoy much of the privacy and choice they would experience if they were still living in their own homes.

In the survey, "Culture Change in Nursing Homes: How Far Have We Come?", only five percent of nursing homes report that the definition of culture change or resident-directed care "completely" describes their home.

Moreover, 25% of respondents indicate that their nursing home "for the most part" fits the description of a culture change. Researchers note that 31% of surveyed nursing homes are considered culture change adopters.

Twenty-five percent of nursing homes explain that the definition of culture change describes their facility "in a few respects" or "not at all," but leadership is "extremely" or "very" committed to adopting culture change.

The remaining 43% of facilities, traditional nursing homes, say that the definition of culture change describes their nursing home "not at all" or only "in a few respects" and the leadership is only "somewhat," "not very," or "not at all" committed to the adoption of culture change.

"The survey shows that in facilities that incorporate some aspects of culture change, the more culture change initiatives that are under way, the greater the benefits in terms of staff retention, higher occupancy rates, better competitive position, and improved operational costs," researchers note.