Leslie Norwalk, Administrator of the Centers for Medicare and Medicaid Services, received a letter from the Mississippi congressional delegation endorsing culture change principles and the Green House model.

Administrator Norwalk replied with a letter describing the many activities that CMS is pursuing to "engage in communication with culture change innovators and to inform our survey agencies of how these innovations can comply with Federal requirements."

The letter was sent to Senators Cochran and Lott, and Represenatives Taylor, Pickering, Thompson, and Wicker.

Open a .pdf version of the letter by clicking here.

There's a tremendous amount of education happening on the topic of regulations and culture change around the country. Action Pact has new "Featured Stories" up on their website that include some great insights from Pat Maben and Glenna Massey, as well as a review of the NHRegsPlus website out of the University of Minnesota.

And in Kansas, the Kansas Association of Homes & Services for the Aging recently helped to sponsor trainings that featured regulators, providers and ombudspeople in the same room exploring culture change scenarios:

Carmen will be speaking at the Ohio Person-Centered Care Coalition's 2nd annual conference in Columbus on March 20th (sold out) and I will be there to live blog it. There has a been a fascinating exchange on the Ohio coalition's listserv recently about the survey process concerning call bells -- it has proven to be a great education for all involved.

More about the bill passing the Arkansas House & Senate here:

The California Culture Change Coalition is off to an exciting start in 2007, having incorporated as a 501(c)(3) on February 1. I attended the coalition's meeting in Sacremento on February 2 and spent the day talking with a diverse group of coalition partners. I came away hoping that the old adage, "As California goes, so goes the rest of the country" holds up in this case, because they really do have all the stakeholders around the table and are poised to do great work.

California is fortunate to have involved in its coalition several folks with a tremendous amount of experience implementing person-directed care practices and building community across the long-term care spectrum, including David Farrell. They also have founding Pioneers Barry and Debby Barkan.

I was lucky enough to be able to spend some quality time with the Barkans while staying in their Berkeley home. Barry shared with me an article he wrote for Aging back in 1981. It's based on a talk he gave at a UC Berkeley conference the year before, and he said it was carried around by Carter Williams for several years before she ever met Barry. It very much captures the spirit of OBRA 87!

Reading the paper for the first time on the plane ride home, I thought about how it's truly a foundational document in the culture change movement -- something everybody should read because it captures the essence of what this work is all about.

I highly recommend downloading it (opens as a .pdf) and sharing it with others. Hold a learning circle in your organization and discuss it, or honor Barry and Debby by making it the topic of a community meeting!

The NBC Nightly News "Trading Places" series continues this week. They are sharing stories from viewers and exploring elder care issues in more depth.

On Monday night they ran a wonderful story about Rakhma Homes in Minnesota. Several Pioneer Network board members and staff visited Rakhma while in Minnesota a few weeks ago for a board meeting (thanks to the Minnesota Health & Housing Alliance for helping to arrange the visit).

The piece about Rakhma ended with a comment that residents are "not in a home, they are at home." It would be great if NBC were to explore that concept more and show how a small but growing number of nursing homes are doing truly remarkable work individualizing care and de-institutionalizing services -- and also share how some nursing homes with more resources are transforming themselves into households and neighborhoods.

It's really important to raise awareness about nursing home alternatives as that will spur innovation in all areas. But we can't lose sight of the fact that we have 15,000+ nursing homes and approaching this as a zero sum game (home & community-based care VS. nursing home care) is not useful. In many communities, the nursing homes that are undergoing a transformation represent an incredible resource for educating the broader community about the need to invest in a direct care workforce, one that can serve individuals with chronic care needs across the long-term care spectrum. Think of what the Green Houses are doing in the communities where they're being built -- they are nursing homes undergoing a deep transformation, and there are many other nursing homes adopting other approaches to creating households (for example, over 200 Household Matters Toolkits have been distributed). The stories of those organizations deserve to be heard too.

Last night's program featured Dr. Marie Bernard, The Donald W. Reynolds Chair in Geriatric Medicine at the University of Oklahoma. You can read her blog here.