B&F Consulting, Inc.


From Institutional to Individualized Care

Part Three

From Institutional to Individualized Care

Part Three:

Clinical Case Studies in Culture Change

Centers for Medicare and Medicaid Services (CMS)

Originally Satellite Broadcast and Webcast on

Friday, May 18, 2007

  1. Bullet Part Three includes two homes’ stories of individualizing care delivery and adjusting their environment to reflect that their workplace is home to the residents who live there. Medical, nursing, and administrative staff talk with regulators about how their changes align with OBRA regulations. They provide in-depth discussion of changes to their dining services and reducing their medication pass.


To inform surveyors and providers about changes being made to medical and nursing procedures in two nursing homes that are changing their culture to provide better quality of life for residents.


  1. Bullet Provide a nurse surveyor’s point of view about the culture changes providers have been making and how they relate to the regulations and the survey process.

  2. Bullet Provide information about how nursing homes have been making changes to medical and nursing care.

  3. Bullet Explain how to make changes to care and medication schedules to accommodate what time residents like to get up in the morning.

  4. Bullet Explain medical, nursing, and operational issues for homes that want to change their food service practices


Karen Schoeneman, MPA, Director, CMS Division of Nursing Homes

Theresa Bennett, RN BSN, CMS Dallas Regional Office

Debi Majo is Director of Nursing at the Northwood Health Care Center in Marble Falls, Texas.

Pam Riter, Director of Nursing at Eliza Jennings Senior Care Network Cleveland, Ohio

Dr. Matt Wayne, chief medical officer, Eliza Jennings Senior Care Network Cleveland, Ohio

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

Time: 60 min. 1 sec.

Click for:

  1. BulletFIIC Part One

  2. BulletFIIC Part Two

  3. BulletFIIC Part Three

  4. BulletFIIC Part Four