Jeff -- I think it speaks to another challenge we all face and that's sharing information about culture change developments in long-term care to the broader medical community (doctors, nurses, health care administrators) who are slowly adopting the concept/philosophy of "patient-centered" care.  The leap to person-centered is more obvious than person-directed for that community, just in terms of language.

There's a fundamental difference between what we expect from a hospital experience -- we do expect to be at the center of care-planning and to be treated as a whole person, but because the hospital is not home we don't have expectations about fundamentally directing our daily routines (i.e., we put up with a lot because we know it's temporary and we just want to get out of there and "back home").

Perhaps that distinction could actually be used to educate the medical/hospital community about culture change in long-term care settings, as most elders who have a hospital experience also have a post-acute and then long-term care experience (nursing home, assisted living, or home care).  So the question or teaching heuristic then becomes, what are they going home to, whatever the setting?