I've got a few ideas that immediately come to mind - First, I attended one of the breakout sessions at this year's conference that I feel everyone should see. I'm not sure if it's possible, but Karen Strobbe's "Sometimes Ya Gotta Laugh" presentation is light, funny, heartwarming, and most importantly, real.  It brings everything back to why we do this work.  I would like to see that presentation included in one of the general sessions for all in attendance to see.
Secondly, I would like to hear from others in the business that have made significant structural changes and find out how they paid for them.  I have received quotes to make some structural changes that would significantly impact our resident's lives in a positive way, but I have no idea how to pay for them.  As everyone knows, we operate on such tight financial constraints, that changes like these seem impossible.  Obviously they are possible, because other organizations have made significant improvements to their physical plants.
Thirdly, from a State Coalition perspective, I would like to hear from other Coalition members on how they are promoting Resident Directed Care.  What's worked, what hasn't, and how have they paid for their work.  Hearing from other Coalitions that are at different stages of development would be a huge help to our "young" Massachusetts coalition.

The first thing that comes to mind for me is inviting speakers well on the journey who have done so in spite of budget restraints, and other structural hurdles. There are some very passionate change agents I know who are proving that demand drives the dollars and are pushing well beyond any physical limitations of their building's structure. Also we could learn so much from hearing from more end users rather than providers.

Lee Kroencke, Americare

It would be fun to bring the original Pioneers (who formed the Pioneer Network) together to talk about where the culture change movement was then compared to now and how their perspectives on changing the culture of aging have grown since those very first days. What lessons have been learned, what achievements have been made, how have lives been changed, what work still lies ahead and what we can do together.

First of all, a disclaimer, and a big disclaimer, that our company (It's Never 2 Late) sells adaptive computer labs into the world of nursing homes.  Many people in the PN world know me and my passion about how adaptive technology can transform lives, but I need to make it clear that I do have a business bias in this discussion.

I strongly feel that the world of technology, presented in an elder first context, needs to have a forum at the conference.  The world of long term care is beginning to embrace technology (often times kicking and screaming), but usually in an operational or reimbursement context.  If you take a big picture look at whats going on with the explosion of multimedia content, on-line gaming, the acceptance of "You Tube", the integration of television and the internet, etc., etc., etc.  All of these experiences fit perfectly into a culture change context, as there are dozens of ways to connect with families, engage elders with varying degrees of dementia, and allow lifelong learning to continue.  What I loved about last years conference was how we had set up (with our colleagues at LifeBio.com and our friends from the Institute for Caregiver Education) workstations where elders came in an proudly showed off their expertise.  It was  memorable for them, and an eye opening experience for attendees.  I think that type of experience should be a consistent happening from year to year.

Jack York

WOW - I keep writing this one word to respondents to our request for ideas and suggestions! Keep them coming! Thank you for sharing and don't hesitate to do it again. There are some themes that are beginning to emerge! Certainly hearing from those on the journey about trials and tribulations is one of them,  Please send me names of folks (elders, families, staff) who can share this kind of information and do it in a way that is clear, concrete, motivating, and interactive. I need names and contact information.
Jack you'll be glad to hear many folks have suggestions around technology in its infinite variety. And the "ongoing' experience was a big hit with many people last year - maybe we can do more!

With involvement like this we will collectively create a powerful learning experience for all! This is exciting, accolades to all of you!
Megan

If you follow the thread back to its source, culture change in long term care is an attempt to replicate community, neighborhood and family. We have deligated these relationships to government and institutions and it is working for none of them. "There are nothing but old people here" is the result.

One of the solutions is Intergenerational programming. There are huge benefits to both children (especially pre-schoolers) and elders when their respective institutions are brought together intentionally. So I would urge you to include presentations and break out sessions on how to make intergenerational programs happen.

Thanks  Christopher Murray

I would like to hear some discussion about whether we need nursing homes at all anymore.  Nursing homes may be inherently places where it is very difficult to create and maintain the community that we see as critical to allowing a good life.

The advocates for persons with mental retardation I think realized that the state institutions couldn't be reformed and by and large got them abolished. That has meant in some states that very few people live in institutional settings today.  Unfortunately, in some states many people with mental retardation have just traded in a state institution for a privately run nursing home.  It is important that we don't just trade what we have for new, less regulated institutions. I think a discussion about an NH abolitionist approach as an important long term direction and its potential positives and negatives would be good.

I thought a number of the presentations last year on co-housing and naturally occurring retirement communities were quite worthwhile and maybe should be brought to the full audience.  Some of the economic realities of this would be important to address as well.  This also has the potential to get into some of the intergenerational issues that are noted in an earlier comment.

I would like to hear from the worker owned home care agency in NY and how that has worked and what consumers and workers think about that development.

My last thought is that some discussion of the quality improvement approach to person centered care would be important.  Given the title of the whole conference that may be already planned.  I would see a discussion/debate about the merits of the incremental versus the transformational approach to what we are trying to accomplish.

I look forward to coming to Minneapolis.
Pat Murray

I would second the suggestions of Karen Stobbe, technology, alternatives to NH, finances, naturally occurring communities and including more elders and family members in the conference. These are all important topics as we move forward. I am grateful for the interest and input into the planning
Joanne Rader
PN Board member

I agree with Kate Ricks - we really need more families and residents getting into the Culture Change movement. Getting those involved who are receiving the services (or not so good services) is a big part of making change happen.
Also, having those providers (and their residents & family members)who have already made changes, present how they started their culture change process. What were the first steps; how did they all decide on what changes to make first and how did that fit in with the long term goals. In my experience, it seems that some providers don't really understand culture change. Culture Change is not soley about more food choices, cosmetic changes, or management making the best decisions (or thinking they are) for the residents (and not involving the residents/families).  
Nursing homes are just not working the way they are now! We need to get people excited about how things can be and give them examples of small steps to get started.
Kim - LTC Ombudsman

How about a topic related to creating an online peer-to-peer support network via the internet? A couple of organizations have tried to start it, but the engagement of providers has not sparked yet. Perhaps a speaker with some education about these internet resources and how to leverage them for the culture change journey could be valuable in getting these communities chatting!

Recently a group of around 135 folks gathered to participate in an Open Space meeting on Person Centered Care.  The group involved interested persons from various organizations associated together in an alliance.  The Open Space format allowed folks to develop the agenda together on the fly, effectively encouraging those with a desire to discuss something to lead a group.  It was a great experience for me to see such an equalizing environment where every voice has a good shot at being heard and you vote with your feet should you wish to be elsewhere.  Listed below are some of the groups that emerged on their own during the day:

1. How can Senior Teams be more person centered?
   
2. How to work with regulations
   
3. Integration or Segregation of Dementia?
   
4. Flexibility of Dining
   
5. What types of people skills are necessary?
   
6. How are activities changing?
   
7. Staff Buy In
   
8. Choices and Options for Reversing Institutionalization
   
9. How do you really break down silos?
   
10. Leadership Development

Those ideas were what was on the mind of that group on that day and may be helpful to consider.  Another suggestion is to have an Open Space experience at the conference.  It has the potential to provide an environment where the group present creates their own experience most meaningful to them.  It becomes much less of an information push and one of collaboration. Everyone is an expert. One thing I have apppreciated about the pioneer conferences is the ablility to experience something different such as learning circles or a fishbowl session.