But the foundation of culture change is getting nursing home administrators to change their leadership style, so change comes from input from residents and staff.

"That’s a culture change in itself," said Barbara Frank, a consultant for the Quality Partners of Rhode Island, which has been working on improving nursing home care for more than 30 years. "Nursing homes are used to being dictated to. That hierarchical dictating-to goes all the way down the line. (Staff members) don’t need to think, (they) just need to follow directions."

St. Camillus Health Center in Northbridge has embraced the change.

"It’s not really a policy, per se, as an attitude and philosophy," said William Graves, the home’s administrator and president. "It’s about giving control of a resident’s life back to the resident. Instead of them having to adopt to our rules and regulations, we adapt to their lifestyle."

The Centers for Medicare and Medicaid Services has embraced the idea and is encouraging nursing homes to adopt the approach. But, in a break from past practices, the government isn’t mandating homes do so.

Instead, it has begun offering grants to hire trained personnel to help homes adopt culture change, implementing some immediate new practices, as well as teaching administrators and staff how to improve nursing practices, resident care and the living environment.

"What gives me hope with this quality of improvement work, is there is... an infrastructure for assistance that is unprecedented," said Cathy Brady, who, like Frank, is a consultant working with Quality Partners of Rhode Island. In the past, when laws were passed to improve nursing home care, "there was no system for helping nursing homes improve. What we have now is free help, around the country, from highly skilled people."

Graves said some fellow administrators said they have been hesitant to adopt culture change themselves, fearing what the change would mean to the home’s bottom line. But Graves said although some staff needed to be shifted, the cost was minimal.

He offers a word of advice to those considering adopting the practice.

"One of the things I would caution them on is, don’t just do the superficial things. Discovery frames, memory quilts and cookouts are good ideas, but what’s important is how we got to those things," he said. "It’s about a change in attitude and a change in philosophy, from leadership as well as every staff person."