If you want to know Karen Schoeneman’s boss, just look behind her computer screen. There sits a photo of 108-year-old Mamie Legg. The now-deceased nursing home resident is shown learning audio e-mailing with the help of a social worker.

“We all work for Mamie,” says Schoeneman, deputy division director for the Nursing Homes Division at the Centers for Medicare & Medicaid Services. “The only important thing is that she has a good day, good life. Somebody knows about her, cares about her, even loves her.”If this doesn’t sound like typical government-speak, then you’re beginning to understand Schoeneman. While she has spent more than 20 years at CMS, she always has had one foot planted in the world of resident advocacy. A founding member of the Pioneer Network, she has worked to make culture change a household word at CMS—and succeeded. Among her proudest accomplishments is revising quality-of-life guidance for surveyors last summer.

“She’s been a very powerful force in the agency, not only working externally but internally to make positive change happen,” says Mary Pratt, director of the Division of Chronic and Post Acute Care at CMS.

Even those likely to disagree with Schoeneman’s policy ideas can’t deny her commitment to long-term care residents.

“To me, Karen is the champion for culture change at CMS,” says Evvie Munley, senior health policy analyst at the American Association of Homes and Services for the Aging.

Schoeneman always has been a fan of the elderly. As an only child growing up in Pottsville, PA (population about 15,000), she would make daily “rounds,” visiting a few older women on her street. She often preferred the company of the women, who helped her hold a china cup and address an envelope, to her playmates, she says.

Starting out as a social worker in large healthcare facilities she saw the negative impact of institutionalized care.

One commonly accepted idea back then was that facilities were too overwhelmed to give anyone special treatment.

As a result of the culture change movement, she now knows such thinking “is wrong, and we can [give personalized attention], and here’s how,” she says.  

Schoeneman, who is not married and does not have children, could be a poster child herself for quality of life. The avid gardener likes to hike and go to the beach. She still is waiting for the day a co-worker will toss a rubber ball around with her at lunch. One colleague recounts a few years ago when Schoeneman adorned her sparkly convertible Mustang with bumper stickers espousing positive change.  

The national acceptance of culture change has made Schoeneman only more optimistic about the nation’s potential to improve care for residents.

“I remain enthusiastic,” she says. “You cannot dampen me down no matter what you do. Things will definitely keep on getting better.”



Graduates with B.A. in psychology from Pennsylvania State University

Employed as social worker at state facilities in Cresson and Altoona, PA, for individuals with developmental disabilities

Takes position as social worker at Hollidaysburg Veterans Home in Hollidaysburg, PA

Receives master’s degree in Public Administration from Penn State

Becomes health insurance specialist at agency now known as CMS

Co-founds Pioneer Network, an organization dedicated to promoting culture change in long-term care

Promoted to deputy division director of the Division of Nursing Homes at CMS