Become a registered member of the coalition
Register for information about upcoming events or to get more intimately involved with the coalition. This registration form was designed
to help coalition leaders manage participation efficiently and get participants involved in areas where they have demonstrated interest. Please
take a few minutes to complete this questionnaire. Make sure to hit the "Submit" button at the bottom of the page when you are done.
Barrier Story
Today's Date *
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Contact Name / Title *
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Contact Phone *
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Contact Email *
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Topic of story (Care practice, workplace practice, environment, etc.) *
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Nursing Home Name
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Nursing Home Address
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Nursing Home City
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State
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Zip
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Nursing Home County
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Nursing Home Phone
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What has been one of the biggest barriers you've had to overcome as you've implemented culture change or person-centered
care practices in your nursing home? Please provide a detailed explanation.
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How did you overcome this barrier? Please provide a detailed explanation.
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Other helpful information. (List any barriers you encounter, what your goals were, how long it took to implement, etc.)
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Additional comments
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May we share this informaion on the centerdcare.org website?
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