Nursing homes are governed by a set of regulations intended to promote resident-centered care. Surveyors, however, often interpret these regulations as emphasizing clinical care. As a result, many providers perceive the regulatory survey process to be the biggest impediment to culture change. This project will analyze federal regulatory policies and guidelines to see how they might be used to promote resident-centered care. Working closely with the Centers for Medicare and Medicaid Services, the project team will seek input from providers, consumer advocates, and culture change experts on alternative ways to interpret the regulations. The Rhode Island surveyors will pilot-test, evaluate, and disseminate their enhanced interpretive guidelines to state survey agencies nationwide. In-kind cofunding will be provided by the Rhode Island Department of Health.