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Inform, Transform, Inspire

Advocating for Change in How and Where We Age

Pioneer Network's Community Outreach Tool Kit

We are all aging. Aging is a privilege! As we age, we might need to seek help in our day to day lives. The issues that we face now regarding the delivery of quality long-term care for elders and others in nursing homes and other care settings will continue to grow. But as you already know, we don't have to accept things as they are. Thanks to you and many others, change is already underway in our nation.

Many long-term care settings have changed.  More need to. Informed consumers will play an important role in driving demand at the community-level.

Be an Ambassador for Change in Your Community!

Inform more people about efforts to promote person-directed living and give them the tools they need to be a more knowledgeable consumer.

Transform conventional thinking and expectations for care settings, which in turn will promote transformation throughout the care-continuum.

Inspire more people to join with us to be part of the change -- to advocate for care settings that embrace Pioneer values where an individual's dignity and choice are preserved; where their voices, and those of their caregivers, are heard and respected.

Within these web pages you will find useful tools for an unlimited number of successful consumer group presentations in your community. Please complete the survey (at the end of this page) following each of your presentations to let us know more about your outreach efforts. Thank you!


There are many groups and community venues where you can make a presentation. 
  • Faith community
  • Public Libraries
  • Service Organizations (such as Rotary, Lions Club etc)
  • Clubs
  • Alumni Associations
  • Area Offices for the Aging
  • Caregiver Support Groups
  • In collaboration with other agencies serving elders and persons with disabilities with whom you may be affiliated (such as the Alzheimer's Association, etc.)
  • Lifelong learning organizations
  • Adult day centers

  • PowerPoint with talking points 
    DOWNLOAD a pdf annotated with script notes to provide the basis for your presentation. We strongly encourage you to make it your own, and use your own voice.
    DOWNLOAD the PowerPoint slides.
  • My Daily Routine activity sheets DOWNLOAD
  • What is Culture Change handout DOWNLOAD
  • What Does Culture Change Look Like handout DOWNLOAD
  • Common Consumer Comments/Frequently Asked Questions
    Click here to see common issues that may arise and suggested responses
  • LCD Projector and laptop to show presentation (The venue you choose might have other audiovisual equipment you can use to show the presentation. Let them know you will have a power point presentation.)
  • Pens/pencils
  • Refreshments, if desired


Key Questions
Pioneer Network offers a comprehensive list of key questions to ask when visiting nursing homes and assisted living centers to find out if they provide person-centered care. Click here to see the questions, or:
DOWNLOAD Key Questions for Nursing Homes
DOWNLOAD Key Questions for Assisted Living Communities

Glossary of Terms
The language of long-term care can be confusing for many. Click here for a glossary of terms commonly used in long-term care and in culture change, or:
DOWNLOAD Glossary of Terms

Click here to access Creating Home: A Guide to Better Care Options for an Aging America for additional information that may be helpful in preparing your presentation, or:
DOWNLOAD (64 page document)
Click here for a comprehensive list of national culture change resources.


Let us know how it went!  Please complete the survey form below. Your feedback will be shared with other facilitators to help them prepare for their own presentations, help us improve our tools and is also important in terms of keeping track of how many consumers we helped learn more about culture change and creating a better way of aging in your community, and around the nation.

Supported by the Picker Institute, Inc., an international non-profit organization based in Massachusetts that supports research and education in the field of patient-centered care.

Special thanks to Colorado Culture Change Coalition.

Click here to go to Pioneer Network's For Consumers online guide Creating Home: Better Care Options for an Aging America

Contact Us if you have questions

Common Consumer Comments/Frequently Asked Questions

Pioneer Network's Creating Home: Advocating for Change in How and Where We Age consumer education project has held meetings with consumers in 22 states. Through feedback received from these meetings, we have compiled frequent comments that we anticipate you will hear during your presentation. We offer some points that might be helpful to include in your response.

Culture change seems very expensive.
Culture change only happens in "high end" nursing homes.
A resident pays more for a nursing home that has culture change.
You have to be wealthy to live in a culture change long-term care community.
Does culture change happen in homes that take Medicaid?
  • Culture change is a philosophy of person-centered care that can be adopted by all types of long-term care communities and service providers . This includes nursing homes and assisted living communities that serves individuals of all financial means.
  • On average, at least half of the residents in culture changed homes are covered by Medicaid
  • The physical environment is one part of culture change but it is not the only part. The most important part of culture change is putting the needs, interests, and lifestyle choices of residents at the center of their care.  A long-term care community may look "homelike" and be decorated nicely but the care might not be person-centered. "High-end" long-term care communities do not always practice person-centered care.
  • There is evidence that homes that practice culture change benefit financially, in less staff turnover, higher occupancy rates, etc.
  • Nursing homes are encouraged to think about how to change their environment when they have a chance, like when they are remodeling or building new buildings.
  • Physical changes and renovations can be expensive. However, large scale renovations are not always necessary or feasible, especially when communities are starting culture change. Certainly, it would be nice if all nursing homes could change their environment so that they have things like private rooms, kitchens accessible to residents, etc. However, financial limitations might prevent a nursing home from doing this right away. For low cost environmental changes to create home for nursing home residents, see "Design on a Dollar" on
This sounds like assisted living.
  • Assisted living residences are often home-like and are generally less institutional than nursing homes. However, we cannot assume an assisted living community practices person-centered care just because it looks less institutional and more homelike.  The values of person-centered care must be evident in assisted living as well, which means putting the needs, interests, and lifestyle choices of residents at the center of their care.
Does culture change happen just in nursing homes?
  • The principles of person-centered care are applicable across the continuum of long-term care and aging services, regardless of where an individual receives care. This includes home care, adult day centers and other home- and community-based services, as well as residential care options such as assisted living, senior housing, and "active" retirement communities.
Why isn't every nursing home involved in culture change?
What are barriers to culture change?
  • Culture change takes a commitment from all levels of an organization providing long-term care services (including but not limited to nursing homes). For example, if leadership of an organization is not on board, it is very difficult for the organization to change.
  • Culture change involves significant changes in the way an organization operates. Time is required to rethink processes and how to implement new ideas. Central to this is involving all of an organization's stakeholders, including residents, family members, staff, and volunteers in determining what the changes will be and how they will be implemented.
  • Change can be fearful for many people, especially those who have been doing things a certain way for a long time.
  • Because they are traditionally the most institutional, nursing homes may need to make the most significant environmental changes. So, culture change can cost a lot of money if significant renovations are involved. There is sometimes a perception amongst long-term care communities that they need to "look a certain way" to be involved in culture change. That is not true. The physical environment is one part of culture change but it is not the only part. The most important part of culture change is putting the needs, interests, and lifestyle choices of residents at the center of their care.  Once a community changes its culture, when it's time to renovate or build new, it will likely choose to build the household model or another one of the new models of care.
  • In many cases, long-term care communities or providers may want to change but are not sure how to go about changing. Long-term care is very complex from an operational and regulatory perspective. There are a number of organizations and consultants that can guide a community in their culture change journey. Also,  Pioneer Network has a "Promising Practices" section on its website that includes information and resources for starting and continuing the culture change journey.  You can access this information by going to or
Culture change goes against principles of quality care.
Culture change goes against regulation and law.
  • Culture change marries quality of care and quality of life. Expertise about quality clinical care is used to help residents make informed decisions about their care.
  • Culture change is rooted in federal law with The Omnibus Reconciliation Act of 1987 (OBRA '87),  which changed the quality of care of nursing home residents across America, by mandating enforceable minimal quality of care standards for long term care facilities. The Centers for Medicare & Medicaid Services (CMS) have also supported culture change in its interpretative guidelines given to surveyors whose roles are to determine if regulation is being followed.

Allowing residents in long-term care to make their own decisions about their schedules is too chaotic and will never work.
  • Change is never easy and can be difficult at first. Respecting resident decisions about their daily routines does take changes in all levels of operations. In each setting, staff and residents work together as a team to decide how to best accommodate resident preferences.
Culture change does not apply to people with dementia.
How can people with dementia direct their own care?
  • Person-centered care is appropriate for all individuals, even those with dementia, like Alzheimer's disease.
  • For the individual with dementia who is not able to verbalize what she or he wants, likes or doesn't like, the caregiver who consistently works with that resident knows this information by the individual's body language and/or information provided by the family. For example, a person with dementia may not be able to understand that she needs to be clean, and refuses a bath or shower by her words and actions.  A well-trained caregiver, who knows the person, will have the knowledge, skills, flexibility and equipment to find new and better ways to pleasantly assist her with washing.
  • Culture change involves the family in helping make decisions when the resident cannot make complex decisions.
Does culture change have anything to do with people's cultures, like their ethnic backgrounds?
  • The term "culture change" in this context refers to the culture of long-term care and elder care. However, as a part of person-centered care, understanding and respecting each individual's ethnic background is an important part of them being known as individuals and is necessary in honoring their choices about their daily lives.
What is the difference between culture change and person-directed/person-centered care?
Sometimes you say culture change and sometimes you say "person-directed care." I am confused!
  • Culture change, person-directed care, and person-centered care are often used interchangeably. Culture change refers to the changing or transformation of the culture of long-term care communities and organizations providing elder care, from an institutional model to one that practices person-centered care.  Person-directed or person-centered care refers to the type of care in which the voices of the people receiving care, and those closest to them who are providing them care, always come first. In order for person-directed care to happen, there needs to be a change in culture. Similarly, in order for culture change, person-directed care must be the focus. They are entirely interrelated!
  • At a basic level, they are referring to the same thing.
  • Other terms you might here are resident-centered care, patient-centered care, and relationship-centered care.

Supported by the Picker Institute, Inc., an international non-profit organization based in Massachusetts that supports research and education in the field of patient-centered care.

Special thanks to Colorado Culture Change Coalition.