The following Snapshots illustrate different ways in which states are working to promote culture change in long-term care services. Rhode Island is emphasizing measures of patient-centered care in its regulatory oversight of nursing home quality. Michigan is enhancing its ability to evaluate the state's long-term care direct service workforce, incorporating workforce measures into an overall assessment of its progress on long-term care goals. And Colorado was in the forefront of state efforts to incorporate quality-of-life measures into its Medicaid pay-for-performance program for nursing home facilities, until state budget pressures stalled the program in 2010. Nevertheless, the program developed a blueprint that may be replicated in the future.