There is growing awareness among nursing home providers and consumers that pursuing a strategy of business as usual will not produce better outcomes. Services to residents, human resource practices, physical environments, and management strategies must all be reexamined. An emerging grassroots movement, known within the nursing home field as "culture change," proposes radical transformation. A diverse group of nursing home providers, gerontologists, and researchers have banded together to form the Pioneer Network,⁽³⁰⁾ a resource clearinghouse for innovative practices and a peer support system for quality improvement. Last summer, with partial support from the Fund, the Pioneer Network convened a national meeting in Chicago that drew 600 attendees from 34 states; one outcome was the creation of a listserv of people interested in advancing a research agenda on resident-centered care. The Fund is also assisting the Pioneer Network with the development of its website and the completion of a book for providers called Getting Started.

The Fund continues to support dissemination of information about the Wellspring model of culture change.⁽³¹⁾ Originally an alliance of 11 independent nursing homes in eastern Wisconsin, Wellspring now includes about 50 homes in five separate alliances in Wisconsin and Illinois. Mary Ann Kehoe, a founder of Wellspring, has spoken widely about the model to public and professional audiences. This year, continuing support from the Fund enabled strategic planning for the organization's future and spread of the Wellspring model.

Nursing homes routinely collect data about the clinical status of residents (including specific measures such as number of pressure ulcers, ability to walk independently, and cognitive status) for state regulatory agencies and the federal Centers for Medicare and Medicaid Services (CMS). Some information is fed back to facilities as quality indicators, but nursing home personnel have typically been uncertain about how to use the indicators to improve performance. A project led by David Zimmerman of the University of Wisconsin created a prototype curriculum for nursing home medical directors on how quality indicators can be used for quality improvement activities. The curriculum received an enthusiastic reception at the annual conference of the American Medical Directors Association and was featured in a recent issue of Caring for the Ages, the association's monthly membership publication. A project in Ohio is targeting the use of publicly available performance data, this time including information on resident and family satisfaction as well as clinical quality indicators, to assist providers in improving care and helping families make informed choices when selecting a nursing home for a relative.