ABSTRACT
The Veterans Health Administration nursing homes, now called Community Living Centers (CLCs), are engaged in systematic transformation of their environments and their care and work practices. A brief history of nursing home care for Veterans illustrates the competing values that influence CLCs. Monitoring data show that CLCs have reduced institutional features, improved the personalization of care, and empowered direct care staff. Although CLCs differ in many respects from community nursing homes, their experiences offer valuable lessons for culture change, underline the complementary importance of top-level commitment and grassroots engagement, and offer untapped opportunities for research in environmental gerontology.
