Carmen Bowman Keynote/Workshop/Session Descriptions
If you’ve never heard Carmen speak, there is a YouTube clip of her speaking to the Ohio Person-
Centered Care Coalition about highest practicable level of well-being required at Tag 279
Comprehensive Care Plan: http://www.youtube.com/watch?v=dXiYOLQ7XoI and on the Surplus
Safety panel at the Eden Alternative International conference with Dr. Bill Thomas at: http://www.youtube.com/watch?v=pXWwO-7s5jw .
Using the New Dining Practice Standards and Toolkit to Excel in Dining
Stemming from the 2010 Creating Home II National Symposium on Culture Change and the
Food and Dining Requirements co-sponsored by CMS and the Pioneer Network was the creation of the Clinical Dining Standards Task Force which released the new Dining Practice Standards in
2011. The Standards have been agreed upon by 12 clinical standard setting organizations and recognized by CMS. A second Task Force has developed a Toolkit of model policies and procedures, brochures for families and residents and other tools to help teams operationalize the
Standards such as an Informed Choice form. Come learn the Standards, the evidence-based research that backs them, how they were built upon CMS nursing home requirements and about the new tools now available from the facilitator of both the Creating Home II symposium and subsequent task forces. Be inspired to use the new standards to keep improving yours. (Best as an all day workshop.)
Alarms: The New Deficient Practice?
Eliminating Alarms and Preventing Falls by Engaging with Life
Join the discussion to ponder the use of alarms. Could it be that alarms actually fit CMS’ definition of “convenience” which is not to be a reason for restraints at Tag F221 Physical
Restraints and thus actually a deficient practice? Although no research shows that alarms prevent falls and there is evidence that alarms cause people harm, both physically and psychologically, they are still used widely. Eliminating alarms has actually reduced falls in the homes that have committed to no longer use them. Engage yourself and your creativity as we design ways for all staff to engage each individual with life according to his/her daily routine, personal preferences and activity interests and, in so doing, eliminate the use of such impersonal devices while developing individual fall prevention strategies instead. (Half or all day workshop.)
Changing Institutional Culture with Little Money and Worry about Regulations
Can an institutional setting be changed with no – or very little – money? Can person-directed practices be implemented without worry about regulations? If either of these concerns have concerned you come be encouraged and reminded that changing institutional culture can be done without money and how many culture change principles and values can be incorporated into your culture without any link to regulations. In fact, focusing on the persons in your care and those who care for them will actually enhance your compliance with regulatory requirements. (90 min.)
The New Negative Outcome and Harm from Not Honoring Choice
If you live in a nursing home with an “ordered” restricted diet and told “you can’t eat that” for, say, ten years, what kind of harm does that cause? The Hippocratic Oath is “do no harm,” but are we? In her background paper for the Creating Home II food and dining symposium written under contract with CMS, C. Bowman fleshes out this concept of new negative outcome. Ponder it with us along with surplus safety developed by Drs. Ronch and Thomas, the right to folly , the reasonable person concept , the new CMS guidance for Tag F242 “Choices” and research that shows how the opportunity to make choice contributes to brain health. There are positive outcomes from being given choice as well as negative outcomes from not being given choice that not many people are talking about. (90 minute session)
Edu-Catering: Catering Education for Compliance and Culture Change carmen@edu-catering.com 303-981-7228 Edu-Catering, LLP

Living a Life Full of Choices
Since 1987 federal regulation Tag F242 has required nursing homes to honor resident choice. In
2009 CMS issued new guidance reiterating this requirement for choice in waking, retiring, eating and bathing. Institutional living is often known for lack of choice. Unfortunately, institutional ways can creep into even less institutional settings. Be challenged to offer choice in every aspect of living whether you serve people in independent living, adult day services, assisted living, nursing homes or the rehab setting. Most people are used to self-directed living, making choices all day long – it should be no different no matter where we live. (90 minutes)
National Culture Change Initiatives and Outcomes
“The latest” will be discussed regarding the new QIS survey including deficient practice patterns; the New Life Safety Code 2012 culture change changes; the new Dining Practice Standards and
Toolkit; the new Advancing Excellence campaign goals; CMS’ initiatives– all related to culture change. In addition, “the latest” from the Pioneer Network, Rothschild Regulatory Task Forces,
Eden Alternative, Green House Project, Action Pact and other exciting happenings will be shared.
(90 minutes.)
The Power of Language to Create Culture
It is not news that the language of institutional long term care needs some work. Even CMS notes language by encouraging eliminating labels such as “feeder” in its 2009 interpretive guidance for
Tag F241 Dignity. Some are working toward new language, many want to. What is still missing, however, is a language transformation of what is said to whom and how it is said, that conveys the values of a changed culture. This session, built upon a recent Rothschild funded paper with the same title co- authored by our speaker and Dr. Judah Ronch, describes the unintended and negative consequences of the traditional, institutional language of long term care and the way it shapes the cultural experience psychologically for all who live and work there, as well as suggestions for some positive future directions of language and strategies to get there. (90 plus)
Honoring Nurses through Culture Change
Culture change brings with it many new and unfamiliar practices compared to the traditional ways of providing nursing home care. Nurses often get a “bad rap” for not supporting new ideas when, in fact, nurses yearn for meaningful change but have been taught to tread carefully.
Culture change practices will be shared with the responsibilities of the nurse in mind, showing how homes remain compliant with applicable regulations and how new practices actually meet federal requirements better than ever before! We will take a look at some of the things we do and say in long term care that are actually funny and don’t always make the most sense. Come laugh a little and be encouraged along your culture change journey. (Can be a 90 minute session.)
Artifacts of Culture Change
In April of 2006, CMS released a new culture change measurement tool called Artifacts of
Culture Change. It was co-developed by Karen Schoeneman of CMS and Carmen Bowman of
Edu-Catering: Catering Education for Compliance and Culture Change. The tool is designed to be used by an individual home to document concrete changes they have made that reflect the changed thinking of eliminating institution and creating home or, in other words, how “culture changed” they’ve become. Participants will learn how to use the Artifacts tool and become aware of culture change practices they may have not considered in shifting their focus from institutional to individual. (60 or 90 minutes.)
Edu-Catering: Catering Education for Compliance and Culture Change carmen@edu-catering.com 303-981-7228 Edu-Catering, LLP

SOFTEN the Assessment Process
Frustrated with how institutional and awkward the assessment process is? Would you like to offer better for your residents? Learn how all professionals can strive to get to know someone “over coffee instead of over a form” and truly welcome people to their new home helping them through what might be the most traumatic event of their lives. Softening our practice and putting the resident back in the driver's seat of their life fits perfectly with the MDS 3.0 and its focus on resident voice and choice. Ideas shared come from the Action Pact workbook and training DVD with the same title co-authored by our guide. Ideas are for all professionals of all disciplines to soften all our assessment processes with softer practices such as:
Support Simple Pleasures
Offer Options
Foster Friendships
Tie-in to Tasks
Equalize Everyone
Normalize Now (Best as an all day workshop, can be condensed into 90 min.)
Learning from the New CMS Quality of Life Guidance
Have you noticed that the new CMS guidelines are surprisingly person-centered? CMS has acted upon the recommendations given to them at the Creating Home 4/08 national symposium with new interpretive guidance to a number of Quality of Life/Environment regulations including F172
Access and Visitation Rights, F175 Married Couples, F241 Dignity, F242 Self-determination and participation, F246 Accommodation of Needs, F247 Roommate Change, F252 Environment,
F461 Environment, and F256 Lighting Call System. With the release of the new guidance, CMS also made a clarification regarding Tag 371 and the rights of residents to accept food from outside the facility. We can all learn from the influence of the new guidance and each other to promote self-directed care – something we all want - for persons we serve anywhere on the exciting continuum of long-term care. (90 minute session or an all day workshop with leading providers and surveyors willing to share experiences.)
Creating Home II National Symposium on Culture Change and the Food and Dining
Requirements – Results and Recommendations
The Creating Home II symposium held February 2010 will be reviewed by the speaker who was the facilitator of the event and author of the background paper for it under contract with CMS. A synopsis of each content area will be given: The Deep Seated Issue of Choice, The Role of the
Physician Order, Outcomes of Choice in Dining, The FDA Food Code, CDC Infection Control
Guidelines, Survey Interpretations of Regulations, Paid Feeding Assistants, The Role of the
Pharmacist and New Negative Outcome. Recommendations for changes in regulatory requirements, related agency requirements (Food Code, CDC), researchers, academia, professional organizations and standards of practice to support the work of facilities in promoting self-directed living were collected at the symposium and developed further through subsequent workgroups. These recommendations and any momentum since then will be shared.
(60 or 90 min. session or can be turned into an all day workshop.)
Is it Tang or is it Orange Juice? – What is True Culture Change?
“Oh, we do culture change.” But you see what you see and it still looks like an institution. It is easy to get a misperception of what “culture change” is. A company gives focus to a new dining practice and without any other exposure staff think that’s what culture change is. So what does it truly mean to change an institutional culture? It has more to do with principles than programs, individualized care than institutional care, and high involvement than top down hierarchy and being well known than anything else. (90 minutes or more.)
Edu-Catering: Catering Education for Compliance and Culture Change carmen@edu-catering.com 303-981-7228 Edu-Catering, LLP

Oodles of Ideas on Overcoming Resistance to Change
Change – just the word implies hard work and the hair on the back of our necks stands straight up.
We also know the many ideas to change institutional culture are good and we want to implement them but that too is hard work. So how do you get everyone “on board?” Come hear idea after idea and add to the collection of them as we learn from pioneers who have gone before us, brainstorm and encourage one another on this journey that does involve meaningful change.
(60 or 90 minute session with lots of involvement.)
A Meaningful Day
Explore ideas for trading in the daily grind of institutional life for a vibrant daily home life from a new book co-authored by our speaker and LaVrene Norton of Action Pact entitled Vibrant Living .
Many of the book’s ideas were prompted by studying Perham Memorial Home a nursing home in the Household Model where we learned that “programs” are just band aids; one-to-ones can’t sooth loneliness; activity programs often only fill time; and activity staff alone cannot truly engage people. It’s time to move on from “activity programming” to meaningful days with meaningful engagement, momentous moments and more. Be reminded how Tag 248 requires a focus on interests, not problems and Tag 279 requires identifying each resident’s highest practicable level of psychosocial well-being, something not always done. Be exposed to ideas on how to be compliant with the “new” (2006) interpretive guidelines for Tag 248 Activities, and their expectation that basically all staff support resident activity interests by our presenter a former activity professional state and federal surveyor who served on the four year panel that developed Tags’ 248 and 249 interpretive guidance. (All day workshop.)
Building Relationships and Staff Retention – How They Go Together
“Relationship is the foundational building block of a transformed culture.” The Pioneer Network has identified this as a core value to culture change. There are many benefits to encouraging and promoting relationship between staff members, between residents and between staff and residents.
Only in relationship can one truly be known; what you love and what you hate, your passions to your pet peeves, in the end this is all any of us want. Research shows that building relationships even results in decreased turnover and other positive outcomes. (60 minutes at the least, longer would offer experiential exercises.)
Quality of Life: Delineating between Deficient Practice,
Common Practice and Culture Change Practice
For each of the federal Quality of Life regulations, deficient practice, common practice and culture change practice are identified and discussed. At tag 241 Dignity, time is taken to discuss the common use of undignified language in institutions along with suggested more dignified replacements to consider. This session shares some of the content of a workbook with the same title which the speaker, a former surveyor, authored. After an introduction and examples from the speaker, participants will be asked to work together in small groups on various Quality of Life regulations to identify what is deficient practice, common practice and culture change practice and to share with the group at large. This has successfully been presented to providers and surveyors giving them neutral ground to work together. Just such a session in Rhode Island can be read about at www.pioneerexchange.org/story/2006/1/19/121637/817 .
(Can be done as a 90 minute or longer session.)
The CMS Psychosocial Severity Outcome Guide and How to Put It to Good Use
On June 1, 2006, CMS issued it’s first-ever guide to surveyors on how to identify psychosocial outcomes and their severity of harm to long term care residents. Become very familiar with the
Guide itself, hear examples of psychosocial harm, gather ideas for using the Guide with staff and learn how to be proactive in identifying and preventing psychosocial harm. (90 min. or longer.)
Edu-Catering: Catering Education for Compliance and Culture Change carmen@edu-catering.com 303-981-7228 Edu-Catering, LLP

Regulatory Compliance and Culture Change
This session shares the content of a new culture change workbook which the speaker, a former surveyor, authored. Learn how the OBRA ‘87 regulations not only support culture change but how culture change actually embodies what the writers of OBRA ’87 intended.
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A brief history of OBRA will be shared, including a clip from the movie When You
Remember Me depicting life in a nursing home in the early 1970’s.
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How many of the current federal regulations support culture change is explored.
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The new 2009 CMS Quality of Life and Environment Interpretive Guidance is covered.
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At the review of tag F241 Dignity, undignified language used in long term care and dignified replacements will be explored.
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Participants are placed in the role of surveyor in discussing common culture change practices and which regulations pertain to each.
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State regulations, reminders, myths and tips regarding survey and culture change are shared.
(Best as a 3 hour session or two 90 min. sessions.)
Culture Change and Assisted Living
Principles, practices and models of person-directed care will be explored with the assisted living setting in mind drawing from the Pioneer Network, the Eden Alternative, Planetree, Bathing without a Battle, Learning Circles, Community Meetings, neighborhoods, the household model and much more. Many ideas will be generated together and an overview given of culture change resources available and where to obtain them. (90 minute session or longer as more can be covered and time for group discussion.)
Changing the Culture of Care Planning: a person-directed approach
The OBRA ’87 regulations have not only supported a person-directed approach but have required it all along. Do you support your residents to continue to “drive” their lives or are you doing “the driving?” Are you creating care plans in disciplinary silos with disciplinary sections or that reflect the person ? This workshop will free you from the institutional model while showing you ways to create compliance better than ever before. This session shares the content of a new culture change workbook (with the same title) which the speaker, a former surveyor, co-authored covering culture change care planning techniques progressing from personalized to “I” care plans to narrative care plans, what Tag F279 Comprehensive Care Plan requires and what it doesn’t and it’s requirement to identify each resident’s highest practicable level of well-being, creative ways to help staff get to know residents as persons and helping residents to set their own goals as required by Tag 280 all along. (90 min. session at least but can be made as long as all day.)
Activities or Engagement –What’s Missing and What’s Required?
It’s time to move on from “activity programming” to meaningful engagement. This session engages each of us to think about engagement, enchantment, momentous moments and more. Be reminded how Tag 248 requires that focus on interests, not problems; what Tag 279 requires for care planning and what it does not including identifying each resident’s highest practicable level of well-being. Be exposed to ideas on how to be compliant with the “new” (2006) interpretive guidelines for Tag 248 Activities, and their expectation that basically all staff support resident activity interests by our presenter, a former state and activity professional surveyor and basic surveyor trainer with the CMS Division of Nursing Homes, who also served on the four year panel that developed the CMS 248 and 249 interpretive guidance. (90 min. to all day workshop.)
Edu-Catering: Catering Education for Compliance and Culture Change carmen@edu-catering.com 303-981-7228 Edu-Catering, LLP

Blending into a Quality of Life Team
A review of the new CMS Psychosocial Severity Outcome Guide starts the all-day workshop along with learning what constitutes psychosocial well -being. Most of the day is spent discussing how social services and activities staff might become a tighter team dedicated to residents’ quality of life to the greatest extent possible by discussing: Quality of Life – who’s in charge of it?; Assessment - What if we only did one?; End of Life wishes - approaching the subject;
Support groups for helping residents deal with grief and loss; Highest practicable level of wellbeing, meaning and purpose. Tag F279; Putting the person back in the driver’s seat of their life.
Tag F280; Learning Circles and Community Meetings; Resident Council/Neighborhood Councils
– administrators and residents in charge; Drawing from the new CMS interpretive guidelines for
Tag F248 Activities; Discussions of Tag 242 Choices, do we really give them?; Discussions of
Tag 241 Dignity, the undignified language used in LTC and possible replacements. (Best as a half or all day workshop.)
A Pep Rally for the Future of Aging in (states’ name)
We have much to celebrate in the culture change movement both nationally and in (state’s name).
Although many tools for culture change are at hand, it is also easy to experience roadblocks and setbacks on this challenging journey, to be overwhelmed by the “YES, BUTS”. This (very good as a closing or opening) session will be a sharing of encouragement and enthusiasm to overcome those setbacks through a frank dialogue on how to move forward. Bring your “YES, BUT” questions, ideas as well as your unquenchable spirit for change to this, our own pep rally for change. (Best as a 60 or 90 minute keynote or endnote.)
Regrouping, Rejuvenating, and Renewing our Culture Change Commitment
Just as the culture change journey is a never-ending process and occasionally experiences “frost” as Eden has taught us, so it is within the ever-changing state culture change coalition. After identifying and celebrating your coalition’s strengths, we will get to work on its challenges.
Work groups will be tasked with drafting a plan for several top priority chosen areas. Each workgroup will then present their draft to the working board/committee as a whole to deliberate, tweak and prioritize in a doable strategic plan. Also presented will be education on how other coalitions are functioning around the country in the spirit of learning from one another and growing. (A half or whole day workshop for culture change coalition leadership.)
The Pioneer Network and the Culture Change Movement
This presentation is an introduction to the national culture change movement and the Pioneer
Network including the Eden Alternative, the Regenerative Community, Bathing without a Battle, neighborhood/household model with cross-trained self-directed work teams, dignified language and CMS’s support of culture change. The limited culture change resources available and how to obtain them will also be shared. (Best as a 3 hour session.)
Validation® - Truly Successful Communication with Persons with Dementia
Learn how the Validation® method gives a means for successfully communicating with persons with dementia, something desperately needed by them, their caregivers and family members.
Validation replaces the outmoded and person-devaluing methods of sympathy, redirection, diversion, reality orientation, and the therapeutic lie. Validation teaches how to “exquisitely listen,” empathize, “move into” the disoriented person’s world and validate feelings. Using
Validation boosts self-esteem, builds trust and rapport and often assists the person to no longer need to resort to the past by creating a warm and welcoming present. Learn also the value of
Validation groups in which members not only “rise to the occasion” of their individual roles but their intuitive wisdom often spills out to help one another. (All day is best.)
Edu-Catering: Catering Education for Compliance and Culture Change carmen@edu-catering.com 303-981-7228 Edu-Catering, LLP

Public Speaking – Your Greatest Fear? Your Greatest Wish? Or both?
Ever noticed that if you enter into the workforce in health care no matter the setting we always need to educate someone about something? Whether residents/clients, family members, fellow teammates or even ourselves. And it could be about anything too, medical issues, regulations, policies, best practice and more and more about new practices stemming from the culture change movement. Maybe you’ve been asked to do some of the training, maybe this makes you tremble.
Join us for a little encouragement and a lot of chatting through what happens when we speak in public, how to overcome fears and nervousness, what makes a good presentation and where you could do more of it. (90 minutes or more.)
Come on Long Term Care! Be the Best, Smash the Box and get ready for the Baby Boomers
Are your residents still being woken up? Are new residents not allowed to bring their cat or dog?
Are residents being made to wear alarms or eat certain foods? Are they being denied their Godgiven and federally mandated rights? Do we think these offered ways of living will attract Baby
Boomers looking for homes for their parents now and someday themselves? It’s time, don’t you think, to really offer Americans what they really want? Also brainstormed will be:
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Getting Family Members Excited and Engaged – They care just as much about the home where you work as you do.
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Rewarding Staff Longevity and Dedication - which then promotes both
 Competing with your Community’s Best Coffee Shop and Restaurant – really!
(90 minutes to all day.)
Reducing Antipsychotic Medications by Honoring the Person and their Preferences
Half of us do not eat breakfast. Yet the number one driving force in every nursing home every day for getting people up is breakfast. When asked how they would react to being awakened to eat a meal they don’t want, people say “mad” and “angry.” Someone inevitably says they would be “non-compliant” and administered a psychotropic drug. Unfortunately, this is the norm and this is Unnecessary Drugs and Chemical Restraints. This is restraining a person for the convenience of staff and adherence to the “almighty schedule.” This is non-compliance with federal requirements to honor a person’s preferences and choices. What we’ve called behaviors aren’t really at all. They are either coping mechanisms to something one doesn’t want like screaming in the shower or responses to what we do to someone like pushing a caregiver away when one wants to continue sleeping, or unmet needs; is anyone else crabby when they are hungry or tired? It’s time people become so well-known and preferences so well honored drugs are unnecessary and we can join CMS’ National Initiative to Improve Behavioral Health &
Reduce the Use of Antipsychotic Medications for Nursing Home Residents (90 min. to all day.)
Moving Beyond “Memory Care,” “Non-pharmalogical Approaches” and “Activity
Programming” to Engagement with Real Life, Personalized Well-being and Highest
Practicable Level of Well-being – federal requirements actually
It’s time to move away from institutional, generic practices. Who wants to live locked up only with others who have dementia? Who wants to fold fake towels or baby clothes? A well-intended list of “non-pharmalogical approaches” can be non-individualized. And who votes for “activity programming” over engaging in real life? Let’s “take it up a notch.” Real life and personalized well-being includes sleeping until one wakes naturally, spending time outdoors, personalized music, and being strategic about individualized, independent engagement. CMS nursing home regulations require that the highest practicable level of well-
being be maintained or attained for each person and the well-being domains of growth, comfort, security, identity, autonomy, connectedness, meaning and joy are not only what really matter to people but are also embedded in regulatory requirements. (90 min. at min.)
Edu-Catering: Catering Education for Compliance and Culture Change carmen@edu-catering.com 303-981-7228 Edu-Catering, LLP

How Nurses/Dietitians/Activity Professionals/Dietary Managers/ Therapists/ CNAs/
Administrators (insert any profession) Will Save the World of LTC
What people want is their life, their normal life the one they’ve led their whole life before moving into an institution. Be challenged to move beyond the traditional, institutional ways of your discipline’s services to stimulate engagement with life on the person’s terms. Ponder how you can be better utilized as a coach and mentor to engage all staff with residents’ life preferences, routines and interests and how engagement with life can help prevent falls and what we call “behaviors,” eliminate the need for alarms, chemical restraints and more. We will think way outside the box to shake things up, putting the person in the forefront and the institution in the history books. Be inspired again like you were when you began your career and grab a hold of how your profession can change the world of long term living ! (90 min. to all day.)
Good Care should be a Given
Quality of life includes quality of care. In your community, do residents get to the bathroom when they need to? Better yet are residents' bathroom needs anticipated? In addition to the obvious benefits, this also leads to preventing falls. Is mouth care happening regularly every day?
Are medications administered according to residents' schedules? And is sleep honored according to the person's circadian rhythm? Only then can a resident achieve highest practicable well-being.
This is not only a great idea but also a federal requirement. (60-90 min.)
Using the Regulator Role & Regulations to Promote Highest Practicable Quality of Life
Basic needs met should be a given, when they are one can move on and up to reach their highest practicable level of well-being; yet health systems, including the survey process, tend to stratify efforts on the bottom tiers focusing mostly on safety. Using information transfer, the power of language, the right questions, real deficiencies, examples of what compliance can look like, risktaker regulator role models and existing regulations, regulators can don the mask , take up the cause and promote quality of life and highest practicable quality of life whatever the setting.
(First presented by Carmen as The Lone Ranger and Ray Rusin, Rhode Island State Survey
Agency Director, as Tonto in the keynote for the Association of Health Facilities and Survey
Agencies 2013 conference, could be presented with a gutsy regulator in any state…) (90 min.)
Carmen Bowman, MHS, BSW, Regulator turned Educator, is owner of Edu-Catering, consultant, trainer, former Colorado state surveyor, former policy analyst with CMS Central Office, teacher of national Basic
Surveyor Course, first certified activity professional to be a surveyor, member of CMS panel that developed
2006 guidance to Tags 248 Activities and 249 Qualified Activity Director, contractor to CMS: codeveloped the Artifacts of Culture Change measurement tool, authored the background papers for and facilitated both national symposiums sponsored by CMS and Pioneer Network - the 2008 Creating Home regarding the environment and 2010 Creating Home II regarding food and dining, facilitator of the Task
Force for which she drafted and edited the new Dining Practice Standards agreed upon by twelve national clinical standard setting organizations released by Pioneer Network Sept. 2011 and the subsequent Pioneer
Network New Dining Practice Standards Toolkit Task Force that developed tools to help communities implement the new Standards, Certified Eden Associate and Eden Mentor, Certified Validation Worker and
Group Practitioner, co-founder Colorado Culture Change Coalition, author of eight culture change books and web culture change talk show host of Conversations with Carmen for Action Pact.
Edu-Catering: Catering Education for Compliance and Culture Change carmen@edu-catering.com 303-981-7228 Edu-Catering, LLP