B&F Consulting, Inc.


From Institutional to Individualized Care

Part Four

From Institutional to Individualized Care

Part Four:

The How of Change: What a difference management makes!

Centers for Medicare and Medicaid Services (CMS)

Originally Satellite Broadcast and Webcast on

Friday, September 14, 2007

Part Four discusses the basics of an effective change process, the importance of inclusive leadership, workplace practices to achieve staff stability, and why of individualized care is better care. One home tells its story of stabilizing staffing to be able to take on change. Several leaders describe the how and why of instituting consistent assignment.

The film features:

  1. Bullet Description of the How of Change - an effective process for transforming from institutional to individualized care

  2. Bullet Exploration of the importance of inclusive leadership with examples from practitioners about how staff inclusion make their changes successful and sustainable

  3. Bullet Identifies workplace practices to achieve staff stability, featuring one home’s journey from high turnover to high retention, and with it high performance

  4. Bullet Demonstrates why of individualized care is better care, with contributions from a physician, nurses, and other practitioners, including Carter Williams, sharing direct experiences with the clinical efficacy of individualized care


The goals of this broadcast are to:

1.Describe a change process that supports the transformation from institutional to individualized care;

2.Explore the importance of inclusive leadership for an effective change process;

3.Identify workplace practices to achieve staff stability; and

4.Demonstrate, through hard data and clinical concepts, why of individualized care is better care.


After viewing this program, participants will be able to:

•Understand the importance of an iterative, inclusive change process;

•Recognize the importance of encouragement, valuing staff, and people development and have concrete ways of being able to put these exemplary leadership practices in play;

•Identify specific ways to improve staff stability; and

•Know irrefutably that individualized care is better care.

Target Audience

This program is targeted to Regional Office and State Survey agency LTC Surveyors, LTC providers, QIOs and Consumers.


Cathie Brady, Co-founder, B&F Consulting, Canterbury, CT

Barbara Frank, Co-founder, B&F Consulting, Warren, RI

Marguerite McLaughlin, Manager of Educational Development,

Quality Partners of Rhode Island, Providence, RI

Supplementary Materials:

  1. Bullet FIIC Part 4 Trainer's Guide.doc

  2. Bullet Slides FIIC Part Four.ppt

The Following People are Featured in this Broadcast:

Karen Brennan is currently the Clinical Services Director for the Salmon Family of Services, overseeing the education and quality improvement process for the nursing department of 4 skilled nursing facilities. She has worked in LTC for 25 years, 23 years with the Salmon Family.

Liz Diaz is a Neighborhood coordinator at Loomis house.  She was one of the first staff to be chosen for that role and has actually helped to develop the role. 

David Farrell has been a licensed nursing home administrator in California since 1989.  Currently, he is the Director of the Care Continuum for Lumetra, California's Quality Improvement Organization.  Prior to joining Lumetra, David helped to transform a nursing home in Oakland and in this interview he talks about that experience.

Sue Fortin is the Director of Nursing at Birchwood Terrace in Burlington VT. She has worked in LTC for 34 years and she has been a DON for the past 6 years. She was a part of the original Committee that developed a unique state sponsored program that helps LTC reward best practice for recruitment and retention.

Bill Graves is the administrator at St. Camillus Health Care Center in Whitinsville, MA. He and his staff have been on a culture change journey for about four years now. He is active in the Massachusetts Culture Change Coalition.

Connie Elzey Kurz, is the administrator of Good Samaritan Nursing Home in New Orleans, LA, and is an RN. Previously, she served for 12 years as the Regional Vice President of Millennium Management, which operates Good Samaritan. Connie spent nine years in the Navy as a reservist and was on active duty in Desert Storm. At the completion of her duty, she was a Lieutenant Commander.

Anna Ortigara is a registered nurse who has focused her practice in the field of gerontology and Alzheimer’s disease for the past 24 years.  She is currently the V.P. for the Campaign for Cultural Transformation at Life Services Network, Hinsdale, IL. She is most widely known as the primary author of the LEAP for the 21st Century LTC Workforce, program of MatherLifeways.

Dr. Al Power is a Physician and he is a Certified Eden Educator.  He is an Associate Professor of Medicine at the University of Rochester. He is currently working on a book about using culture change principles for enlightened dementia care.

Joanne Rader is an independent consultant. She has been a national leader in efforts to reduce the use of physical restraints and to have Bathing without a Battle. She is a founder of the Pioneer Network.

Matt Salmon is the Vice President of Programs Quality and Innovation for the Salmon Family of Services.  Matt joined his family Business in 1996 as Physical Therapist. Matt is guiding the Salmon Family of Services through their culture change process.

Loren Salvietti is the administrator of Quaboag on the Common, a position she has held for 13 years. Quaboag is 141 bed non-profit facility located in West Brookfield MA. that prides itself on the full education opportunities that staff have available.

Mary Tellis Nayak is Vice President of Quality Initiatives for My InnerView, a company dedicated to providing management intelligence for long-term care. Mary developed the first set of standards for Person-Centered Care within the Aging Services department at the Commission on the Accreditation of Rehabilitation Facilities (CARF) as well as standards for Alzheimer’s programs across the aging continuum.

Lori Todd is the administrator of Loomis House in Holyoke Massachusetts.  It is a nursing home that is known throughout New England as the home for other nursing homes to visit if they want to see what a culture change nursing home looks like.  She is active on the MA culture change coalition and the steering committee, and is also a nurse.

Scott West is the administrator at Birchwood Terrace. He has been an administrator for 11 years and been at Birchwood for the past 7.  Scott is the immediate past president of VT Health Care Association. Under Scott’s administration Birchwood Terrace just received a quality award from American Health Care Association.

Carter Catlett Williams is social worker who is probably most known as the convener of the original Pioneers network. She is also widely credited as a key person in bringing the concept of restraint free care to America.  She has long been an advocate for those living and working in nursing homes.

Ann Wyatt, MSW, LNHA is the Project Coordinator at the Cobble Hill (Health Center) and Isabella (Geriatric Center) Collaboration Project in NYC where they are working on person-centered care.

We also have the use of two films for this broadcast. One is Stand Up and Tell Them, produced by Better Jobs Better Care, which gives voice to the experiences of direct care staff. The other film, Works in Progress: Workforce Retention Collaborative June 2005 was produced by the Genesis Healthcare Corporation to capture positive changes their homes as part of a QIO workforce retention pilot collaborative.

Four Part Series:

From Institutional to Individualized Care

This four-part webinar series was produced by B&F Consulting under contract with Quality Partners of Rhode Island for CMS to provide a framework and practical examples to help LTC surveyors, providers, and consumers understand and support individualized care.

The series was produced in collaboration with Karen Schoeneman, Deputy Director of the Division of Nursing Homes at CMS. The series provides guidance to surveyors and practitioners on individualizing the physical environment so residents feel at home, individualizing the morning routine, eliminating alarm use, decentralizing food services, helping residents to a good night’s sleep, individualizing the med pass, implementing consistent assignment, using individualized care to achieve clinical improvements in pressure ulcers, falls, and depression, and stabilizing staffing.

  1. Bullet Part 1, broadcast Nov. 3, 2006, entitled “Integrating Individualized Care and Quality Improvement” - includes information about making the physical environment more home to people, individualizing the morning routine, and eliminating use of alarms.

  1. Bullet Part 2, broadcast May 4, 2007, entitled “Transforming Systems to Achieve Better Clinical Outcomes” - includes information about individualizing the night routines, decentralizing dining services, instituting consistent assignment, and the link between individualized care and reducing pressure ulcers and depression.

  1. Bullet Part 3, broadcast May 18, 2007, entitled “Clinical Case Studies in Culture Change” - includes one home’s story of individualizing their dining services and another home’s story about reducing their medication pass.

  1. Bullet Part 4, broadcast Sept. 14, 2007, entitled “The How of Change: What a difference management makes! - discusses the basics of an effective change process, the importance of inclusive leadership, workplace practices to achieve staff stability, and why of individualized care is better care. One home tells its story of stabilizing staffing to be able to take on change. Several leaders describe the how and why of instituting consistent assignment.

Please note that the quality of this web-based broadcast varies,

due to the mechanics of embedding it this website.

Videotapes can be purchased from


and from

National Technical Information Services

5285 Port Royal Road, Rm. 1008, Sills Bldg.

Springfield VA 22161

Phone: (703) 605-6186

Based in New England, Brady and Frank work throughout the country.

Contact us by email at:

Cbrady01@snet.net or bfrank1020@me.com

or by phone at:

Cathie Brady 860-334-9379

Barbara Frank 617-721-5385

Note: Entire film is 2:32:21.

It is available from www.Pioneernetwork.net

The following excerpts are available to view here:-

  1. Bullet How of Change (Time 18 min. 52 sec.)

  1. Bullet Achieving Staff Stability (playing time 17:23)

  1. Bullet Consistent Assignment (playing time 11:32)

  1. Bullet Rhythm of Life (playing time 2:58)

  1. Bullet Individualized Care is Better Care (playing time 6:34)


Click for:

  1. BulletFIIC Part One

  2. BulletFIIC Part Two

  3. BulletFIIC Part Three

  4. BulletFIIC Part Four

Click for:

  1. BulletFIIC Part One

  2. BulletFIIC Part Two

  3. BulletFIIC Part Three

  4. BulletFIIC Part Four

Click for:

  1. BulletFIIC Part One

  2. BulletFIIC Part Two

  3. BulletFIIC Part Three

  4. BulletFIIC Part Four