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Culture Change



The culture of long-term care is undergoing profound change.  Philosopher Eric Hoffer once said, “In times of profound change, the learners inherit the earth, while the learned find themselves beautifully equipped to deal with a world that no longer exists.”  I hope you will find something here that inspires you to either take your first step on the culture change journey, or your next one.  Please contact me if you are interested in sharing your culture change experience.


Sam Plaster, State Culture Change Coordinator
Telephone:  573-522-8318


Care Planning for Resident Choice

The assessment of risk in long-term care is often an unbalanced exercise.  In order to optimize opportunities for resident choice; to attain each resident’s highest practicable level of well-being; and to mitigate risk, the Rothschild Foundation has created a task force.  This group is charged with developing a care planning process to plan for each resident’s choice when that choice carries potential risk.

The full Process for Care Planning for Resident Choice, which includes blank forms and case studies, are available at,, and

MC5 Regional Meetings

Please visit the Missouri Coalition Celebrating Care Continuum Change (MC5) website at or click on the regional links below to view upcoming meetings near you!

Central (Jefferson City/Columbia)
East Central (Rolla)
North Central (Chillicothe)
Northeast (Macon)
Northwest (St. Joseph)
Poplar Bluff
Route 71 (Nevada)
Southeast (Cape Girardeau)
Southwest (Springfield)
St. Charles
St. Louis
West (Independence)
West Central (Sedalia)

MC5 Regional Map

MC5 Brochure

Person Centered Care Tips

Tip # 1:  Where’s the Focus?
Just as a “selfie” is all about YOUR SELF, Person-Centered Care is all about the PERSON!  So why are we looking at Person-Centered Care?  Please see the flyer here for more information.

Tip # 2:  My Life! My Choice!!
As we take a “selfie” and examine ourselves, we see the things that are important and unique to us.  We have a favorite color, a hairstyle we prefer, and favorite foods we love to eat.  We make many choices each day that make us satisfied or happy.  Please see the flyer here for more information.

Tip # 3:  Care Conferences: Developing a portrait of the person
Care Conferences are the ultimate “selfie!”  The conference is an opportunity to really examine the person and their preferences and needs.  Please see the flyer here for more information.

Tip # 4:  Consistent Staffing
Think of yourself in a new and unfamiliar situation, surrounded by unfamiliar faces.  Imagine this happens almost every day.  It feels like starting out in a new high school over and over again.  Who are all these other people?  How will I remember their names?  There are so many strangers-what do they really know about me?  Now, imagine you also have dementia.  Please see the flyer here for more information.

Tip # 5:  The Power of Huddles: Making sure we all see the same picture
As in football, a caregiver huddle gathers to briefly exchange information, share observations and develop strategy.  Use huddles to pass insights about what really helps each resident feel comfortable and understood, so that all caregivers are equipped to provide the best person centered care.  Please see the flyer here for more information.

Tip # 6:  Me in My New Home
Just as a “selfie” is about YOU, Person-Centered Care is all about the PERSON!  Think of yourself in an unfamiliar situation.  Finding the bathrooms and where to get a cup of coffee or a bite to eat is likely a top priority.  And by the way… who are all these people and how will I remember their names?  Please see the flyer here for more information.

Tip # 7:  Don’t Call Me “Honey!”
Have you listened to yourself and the words you use?  Not only the words, but also the way you say them may be condescending to people.  Using person-centered language is one of the essentials in changing our culture.  Please see the flyer here for more information.

Tip # 8:  Please Pass the Hot Sauce
Food preferences along with the way meals favored (and sometimes flavored) depend on the individual.  Dining should be about more than nutrition.  Please see the flyer here for more information.

Tip # 9:  The Power of Meaningful Activities
We all need to have a purpose: to be needed, to make a difference, to be a part of something.  It is no different for those living in long-term care.  Helping residents find meaning and purpose in their daily life is not just the Activity Director’s job.  Find out what makes an activity meaningful, according to what each resident values. Please see the flyer here for more information.

Tip # 10:  Simple Pleasures:  Preferences and Choices
Learn how to honor each person’s “Simple Pleasures.”  Personal preference is essential in almost every piece of our lives.  Honoring a resident’s choice and discovering their likings can make a big difference in their lives.  Please see the flyer here for more information.

Tip # 11: Communicate Caring When Words Fail
Do I communicate what I mean? A person may ignore my words, yet react to how they view my attitude. Communication involves sending and receiving both verbal and non-verbal messages. As memory loss progresses, words may become confusing, and word-finding is often frustrating. A person with memory loss will often mirror the non-verbal messages of the caregiver, and search for prompts to tell them how to respond. With such communication challenges, how can we acknowledge and support the person’s feelings, when words may not make sense?  Please see the flyer here for more information.

Tip # 12: Person-Centered Care and QAPI
Person-Centered Care is one of nine Advancing Excellence goals — aligned with QAPI –which provide tracking charts and trend graphs to help your home monitor progress on your chosen goals.  While Advancing Excellence supports the QAPI approach, participation does not automatically mean you are implementing QAPI.  Please see the flyer here for more information.

New Dining Standards Toolkit Available Now from Pioneer Network

Medical evidence from recent research studies has demonstrated that restrictive diets for elder individuals in long-term care are of little benefit, and in fact can be detrimental.  Please visit


 Artifacts of Culture Change Tool

There is a tool available to help you assess your home’s progress on the culture change journey. With the assistance of providers, researchers, and contractor Carmen Bowman of Edu-Catering, the Centers for Medicare & Medicaid Services (CMS) developed the Artifacts of Culture Change assessment tool. Through funding from the Commonwealth Fund, the Pioneer Network developed an interactive web-based version of the Artifacts of Culture Change for providers to input and score their data online. Use of the tool is FREE. All identifying characteristics of your home are coded and only you can monitor your home’s progress. However, you can check out the trends in homes across the country. Look at homes like yours: Under 50 residents, 50 to 100 residents, more than 100 residents, in big cities, small towns, urban or rural, profit, not-for-profit, or government ownership, Medicare-Medicaid certified and a combination of characteristics of homes just like yours. For more information please visit

Artifacts of Culture Change



On the Road…to Culture Change  

NHC Healthcare, Maryland Heights

In early August 2015, I attended the national culture change conference hosted by the Pioneer Network in Chicago, Illinois.  During one of the training sessions, someone asked if nursing homes could keep live chickens.  I couldn’t think …to read more and view photos, click here: NHC Healthcare, Maryland Heights

Arbor Health

In July 2015, I visited Arbor Health, LLC in University City. Arbor Health is 45-resident residential care home that is dually licensed with the Department of Health and Senior Services and Department of Mental Health. Arbor Health is an all-male home…to read more and view photos, click here: Arbor Health

Victorian Place of Washington

In August 2015, Section for Long-Term Care Regulation Communications Representative Leslie Sebastian and I visited Victorian Place of Washington and The Arbors at Victorian Place. Victorian Place is a 48-resident assisted living home and The Arbors is a 32-resident assisted living home…to read more and view photos, click here: Victorian Place of Washington

Ratliff Care Center

In April, I visited Ratliff Care Center in Cape Girardeau. The 46-resident skilled nursing home is owned and operated by husband-and-wife team Emmagene and Carlos Ratliff, and their son Mike. They also operate Sprigg Street Manor, a…to read more and view photos, click here: Ratliff Care Center

Dolan Memory Care Homes (Update)

The Neighborhood at Les Maisons consists of four assisted living homes located on a private cul-de-sac in St. Louis.  They are owned and operated by Dolan Memory Care Homes.  The homes are named after French cities, Calais Manor, Clermont Manor, Lourdes Manor, and Lyon Manor.  Each home has…to read more and view photos, click here:  Dolan Memory Care Homes

Parc Provence

In April 2014, University of Missouri Nursing Home Leadership Coach Dave Walker and I led a staff, resident, and family team in completing the Artifacts of Culture Change assessment at Parc Provence.  Parc is a 140-resident skilled nursing home that specializes… to read more and view photos, click here: Parc Provence.

Lincoln Community Care Center (Update)

In 2011, I visited Lincoln Community Care Center (LCCC), a 66-resident skilled nursing and 14-resident assisted living home located in Lincoln.  Recently, Administrator Donna Bowers invited me back to share the changes that have taken place since.  I visited again in March 2015.  One of the first things I noticed was… to read more and view photos, click here: Lincoln Community Care Center Update.

Marshfield Care Center

In February 2015, Section for Long-Term Care Regulation Communications Representative Leslie Sebastian and I visited Marshfield Care Center and Marshfield Place.  Marshfield Care Center is a 77-resident skilled nursing home and Marshfield place, next door, is… to read more and view photos, click here: Marshfield Care Center.

Good Shepherd Nursing Home

In February 2014, I visited Good Shepherd Nursing Home and Residential Care in Lockwood.  Good Shepherd includes a 69-resident Medicare/Medicaid Certified skilled nursing home and 20-resident residential care home, operated by a not-for-profit nursing home district… to read more and view photos, click here: Good Shepherd Nursing Home.

Chateau Girardeau

In February 2014, I visited Chateau Girardeau in Cape Girardeau.  Chateau Girardeau is a not-for-profit Continuing Care Retirement Community that was founded by the Presbyterian Church.  The 40-acre campus includes 37 individual Independent Living homes, 99 Independent … to read more and view photos, click here:  Chateau Girardeau.

To view more home visits, please select the category
“Culture Change-Home Visits” in the search by topic
 box located on the right-hand column of this page.