B&F Consulting, Inc.


From Institutional to Individualized Care

Part Two - Excerpts

From Institutional to Individualized Care

Part Two:

Transforming Systems to Achieve Better Clinical Outcomes

Centers for Medicare and Medicaid Services (CMS)

Originally Satellite Broadcast and Webcast on

Friday, May 4, 2007

Part Two includes information about individualizing night-time care and supporting a good night’s sleep, decentralizing dining services, instituting consistent assignment, and the link between individualized care and reducing pressure ulcers and depression.

  1. Bullet Section 1: Practitioner Experiences in Transforming Care Delivery Systems

  2. Bullet Section 2: How Individualized Systems Increase Your Capability to Meet Clinical Needs

  3. Bullet Section 3: Making it Happen: Barriers and Strategies


The goal of this broadcast is to demonstrate how homes can achieve better clinical outcomes when they individualize their care delivery systems. A holistic, individualized approach broadens the options available to meet residents’ clinical needs so homes are better able to prevent, detect, and treat depression, pain and pressure ulcers, and decrease restraint use. Consistent assignment and participatory management are essential to support this transformation.


After viewing this program, participants will be able to:

•Recognize the benefits of a holistic, individualized approach to night care, bowel and bladder function, activities, and food services;

•Show how individualized care gives nursing homes more ways to respond to people’s clinical needs;

•Identify benefits of consistent assignment and participatory management practices.

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

Sandy Godfrey, Director of Nursing, St. Camillus Health Center, Whitinsville, MA

Connie McDonald, Administrative Director for MaineGeneral Rehabilitation and Nursing Care, Augusta, ME

Paul O’Connell, Administrator of the Beaumont Rehabilitation and Skilled Nursing Center, Westborough, MA

Mike Salmon, CDM, Food Service Director for Salmon Family of Services facilities in Westborough and Northbridge MA

Susan Wehry, M.D, Director of Health Services for Vermont’s Agency of Human Services’ Department of Corrections

Supplementary Materials:

  1. Bullet CMS Trainer Guide_FIIC Part Two.pdf

  2. Bullet Powerpoint Slides FIIC Part Two.ppt

  3. Bullet SCLetter07-07.FIIC Part Two.pdf

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

Unfortunately, Part Two is scripted and stilted, so much of the good content is hard to hear. So we have clipped the most useful excerpts here. Excerpts include:

  1. Bullet Frameworks for Change

  2. Bullet Interviews about Consistent Assignment

  3. Bullet Staff’s Comments after Wearing Alarms

  4. Bullet An Inclusive Approach to Change

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: 15 min. 32 sec.

Click for:

  1. BulletFIIC Part One

  2. BulletFIIC Part Two

  3. BulletFIIC Part Three

  4. BulletFIIC Part Four