One of the most important challenges for the American health care system of the future is providing culturally competent care to an increasingly diverse population. A Fund report summarizes model programs that have reorganized care to respond to the needs of a multicultural patient population.⁽³¹⁾ The authors recommend widespread efforts to hire and promote minorities in the health care workforce, involve community representatives in planning and quality improvement, provide on-site interpreters to assist patients, and generate health information geared to patients' language, culture, and literacy level. Collecting data on the care of specific racial and ethnic populations will also be needed in order to target quality improvement efforts.

Change is also coming to some of the nation's nursing homes. Traditionally, nursing homes have been organized along rigid lines. Residents have been awakened, bathed, and fed according to fixed schedules, with little flexibility for front-line staff to honor preferences or respond to individual needs. But a group of inspiring nursing home leaders has begun to show the way toward a different model of care. Fund-supported evaluations of Wellspring in Wisconsin,⁽³²⁾ a select group of innovative nursing homes in the Beverly chain, and the Green House project in Mississippi are compiling encouraging evidence of increased resident satisfaction, lower staff turnover, and improved quality of care and life. Fund support for the Pioneer Network,⁽³³⁾ a new coalition dedicated to advancing a resident-centered culture in nursing homes, is helping to spread the word through its website and annual meetings.