1. Karen Schoeneman, CMS Bonnie Kantor, Pioneer Network Gaius Nelson, Nelson-Tremain Partnership Culture Change and the Physical Environment

7. Continuum of Person-Directedness Low High Developed by Mary Tess Crotty, Genesis HealthCare Corp, based on the model by Susan Misiorski and Joanne Rader, distributed at the Pioneer Institutes, 2005. Provider Directed Staff Centered Person Centered Person Directed Mgmt. makes most of the decisions with little conscious consideration of the impact on residents. S taff consult residents or put themselves in residents’ place while making the decisions . R esident preferences or past patterns form basis of decision making about some routines . R esidents make decisions every day about their individual routines. When not capable of articulating needs, staff honor observed preferences and lifelong habits. R esidents accommodate staff preferences; are expected to follow existing routines. R esidents accommodate staff much of the time—but have some choices within existing routines and options. S taff begin to organize routines in order to accommodate resident preferences—articulated or observed. S taff organize their hours, patterns and assignments to meet resident preferences.

10. National Long Term Care Life Safety Task Force

13. Moving away from tray service

15. Tasty meatballs

16. Using the stove

17. Normal kitchen life

18. Even washing dishes

19. Isn’t this like home?

20. Moving away from rooms like this

21. To rooms like this, homey with personal decorations

22. wow

23. Moving from hallways like this

24. To a variety of homier spaces

26. Cat is nice, but this long hallway would be better with some chairs