The evolution of caring and learning continues.

Soon after production ended for the September edition of CLTC, a notable figure in the health care world passed away. Dr. Elisabeth Kubler-Ross was most famous for developing the now-commonly recognized stages of death: denial, anger, bargaining, depression, and acceptance.

The psychiatrist was considered a pioneer in the field of death and bereavement, broaching topics in her seminal 1969 work "On Death and Dying" that weren't discussed openly in those days.

When I read the book nearly two decades later, I recall wondering why it took so long for someone to put those thoughts down on paper, yet I recognized that the topic wasn't much more readily discussed in the mid-1980s.

Today, Dr. Kubler-Ross's observations have become more widely accepted than they were in the 1970s. Yet, the lesson that learning takes time remains as fresh now as it did then.

There's no denying that learning from residents and their families can take many forms and it doesn't always happen quickly. The industry is showing signs of evolution during the past five years, however, as we've seen in the Issues and Trends study conducted by Holleran Consulting for CLTC.

Facilities have altered the manner in which they obtain accreditation, market it, and change how to best serve their residents. Moreover, there are sure to be ways in which they'll change further five years hence.

There's both anger and acceptance about the difficulty in keeping residents well nourished. No matter how simple the act of eating might seem, keeping meals appetizing could be the difference between life and death.

There is also denial and a good deal of bargaining involved in our closing articles of our special report on the emerging LGBT population.

Denial in the sense that not all their needs are recognized, and the bargaining is going on as developers look to create facilities around the country.

Such changes speak to the ongoing evolution of the industry, and surely more is coming.

If you have any thoughts on this or any topics for CLTC, please contact me at [e-mail]