||In the last thirty years, reforms in long-term care have focused on the dual objectives of quality care and accountability, broad concepts that encompass individual rights, organizational responsibilities, clinical outcomes, and regulatory control. The movement for "culture change" in long-term care represents a shift in paradigm from medical care models, which prioritize clinical outcomes, to patient-centered care models that add patient autonomy and quality of life to care objectives. Although it is generally acknowledged that more research is needed on the effectiveness of culture change, the movement continues to gain public support in the form of government controls on care quality and development of new care models. However, widespread replication of culture change in long-term care facilities is hampered by the lack of a universally applicable strategy or method for organizational implementation. Different approaches (in the form of operational domains to target), internal characteristics, external environments, and financial resources factor into decisions regarding culture change within an organization. Local "adopters" of culture change thus provide valuable information to prospective owner/ operators of long-term care facilities, given contextual similarities in environments. Their experience may also inform state leaders about recommended regulation, reimbursement supports, or incentives for innovation that would facilitate widespread culture change within the industry. This project represents a case study of two skilled nursing facilities in the state of Utah, identified as exemplars and early adopters of culture change in long-term care. Organizational representatives are interviewed about the inducements, challenges and impacts of culture change initiatives within their respective organization, and results analyzed to offer insight about their experience.