There are nursing homes, however, that wish to provide resident-centered care but for whom joining an alliance of nursing homes is not feasible or desirable. For many of these facilities, the Pioneer Network is an invaluable ally. A diverse group of providers, researchers, and practitioners, the Pioneers began to promote culture change in nursing homes in 1996. Its new Web site, www.Pioneernetwork.net, which was updated with support from the Fund, helps to achieve one of the network's major goals: to serve as a resource clearinghouse and link people and organizations interested in culture change. A new book, Getting Started: A Pioneering Approach to Culture Change in Long-Term Care Organizations,⁽²⁹⁾ which was written with partial Fund support and is featured on the site, should help them on their way.

Many nursing home providers require more comprehensive and in-depth operational guidance in enacting culture change. A Fund-sponsored project led by Steven Shields, one of the leading proponents of resident-centered care and the CEO of Meadowlark Hills, a long-term care complex in Kansas, will provide actual tools for nursing home administrators seeking assistance with their own cultural transformation. These will include a leadership manual, "Tips for Administrators," policy and procedure manuals, human resource management systems, and a quality improvement process that reinforces the core philosophy of resident-centered care.

While most of the nursing homes that are embracing culture change come from the not-for-profit sector, the for-profit side of the industry is beginning to take notice. Beverly Enterprises, the largest for-profit chain in the United States, is working with a consultant to introduce resident-centered care in a small cohort of their facilities. A Fund-supported evaluation of this initiative has already demonstrated to Beverly's top management the potential for this new way of doing business. Staff turnover, an endemic problem in the industry as a whole, has dropped and far fewer agency workers are needed to cover vacant positions. At one of the homes, staff reported they would quit rather than be expected to work under the old system again. In light of this compelling evidence, Beverly will be expanding the initiative into 10 more of its homes in the coming year.

States are increasingly feeling the impact of an aging America on their budgets. Long-term care, in fact, was chosen by the National Governors Association (NGA) as the priority topic for 2004 and made the focus of a Fund-sponsored NGA Policy Forum and Task Force Meeting held in May in Chicago. Senior state officials from 30 states attended the event, which featured a panel of speakers including Josefina Carbonell, U.S. Assistant Secretary for Aging, James Marks, M.D., senior vice president, Robert Wood Johnson Foundation, and Rick Surpin, founder of the Paraprofessional Healthcare Institute. Workgroups met following the sessions to craft action plans to take back with them to their respective states.