The Fund also has supported the development of the Wellspring model, in which nursing homes join together in ongoing quality improvement collaboratives. This past year, two new Wellspring alliances have been created, one in Maryland and one straddling North and South Carolina. In addition, Wellspring Innovative Solutions, the entity formed to disseminate the model, has developed a package of training materials that can be used by quality improvement organizations (QIOs).

Some nursing home facilities require practical guidance to put the tenets of culture change into practice. With Fund support, Stephen Shields, a leading proponent of resident-centered care and the CEO of Meadowlark Hills, a long-term care facility in Kansas, is producing a comprehensive "toolkit" for nursing homes operators, including a leadership guidebook, policy and procedure manuals, human resource management systems, and a quality improvement process that reinforces the philosophy of resident-centered care. Shields and his mission were the focus of a CBS News segment in October 2005.

As part of its new Nursing Home Quality Initiative, the Centers for Medicare and Medicaid Services (CMS) is making QIOs responsible for improving nursing home quality and requiring them to promote resident-centered care. To take advantage of this opportunity, the Fund is supporting the Pioneer Network, a diverse group of providers, researchers, and practitioners with long experience in nursing home culture change, to share its expertise and resources with QIOs and others interested in nursing home quality. The Pioneer Network's "Summit 2020" provided an opportunity for newcomers to the culture change movement to meet the leaders, develop a shared understanding of resident-centered care, and map out strategies for change.

CMS's "Eighth Scope of Work" for QIOs is to bring culture change to at least 10 percent of nursing homes in each state. To accomplish this, QIOs are expected to build coalitions of key stakeholders within their states. A Fund-supported meeting led by the Rhode Island QIO—the leading Nursing Home Quality Initiative—brought together interested parties to form such coalitions and begin work on state-specific action plans. Known as the St. Louis Accord, the gathering was attended by 377 people from all 50 states, including ombudsmen, surveyors, QIO staff, and members of nursing home trade associations.