People who make a difference.

It is a privilege to recognize those in the industry whose advocacy, attention to detail, innovation, leadership, and understanding serve as an inspiration to others in long term care. This year's five honorees have set new standards in advocacy, design, and creativity. We are sure their mark will be an indelible one, and that their impact will continue to be felt for a long time.

SARAH GREENE BURGER

Voice of the people

IT'S A PRICKLY JOB BEING AN ADVOCATE OF reform. When Sarah Greene Burger is asked how she thinks she is perceived by the long term care industry, she laughs. "Like a thorn in their sides, I would hope," she responds.

As executive director of the National Citizens' Coalition for Nursing Home Reform (NCCNHR) and chair of the Campaign for Quality Care, an industry forum of 50 organizations, Burger brings the voice of the consumer to the table of nursing home care. "We're the folks who say, 'Look, you're not doing the right thing,'" she says. "It's tough for nursing home providers. People fight with us and I'm sure they'd like to see us disappear. But that's our job. We're the only ones out there doing it, so we have to keep at it."

Burger's consciousness was raised back in the 1980s when she was working with Elma Holder, then-director of NCCNHR, and Barbara Frank, who created the Campaign for Quality Care. The upshot of that think tank was OBRA '87, the nursing home reform act. Working on a study commissioned by AARP at the time, Burger interviewed nursing home residents around the country. Along with stories of good care, she heard hair-raising tales of life in a nursing home. "I was shocked," she says. "As a professional nurse, I hadn't had the vaguest idea of what it was like to be a resident. Most nurses probably don't. That one experience radicalized me--it changed how I viewed what had to be done."

Emphasizing training and certification

Nurse aide training and certification became a focus. She also took on the issue of industry use of physical and chemical restraints. "From a consumer's point of view, restraints were an outrage," says Burger. "Nothing in the literature showed that was a good thing to do, and everything showed it was a bad thing to do."

VICTOR REGNIER

Designing a better industry

So Burger used a speaking engagement at an American Health Care Association conference as the bully pulpit, switching her topic at the last minute from nurse aides to restraints. "I talked about removing restraints at a time when it was not a happy topic," she says. "The people in that room were not tickled. When it came down to how to do it, everybody was frightened to death."

At least one woman in the audience got the message: Vivian Wisdom, head of New Hampshire Health Care Association, reduced the use of restraints in the Granite State to 5 percent of all residents in the following year. Since then, the industry has accepted restraint removal. "That teaches you that if there is something right, you have to say it," says Burger. "If you can change one mind, that person may carry the water for you."

With a grant from the Retirement Research Foundation and with input from the Campaign for Quality Care, Burger wrote two books for consumers on the subject. She has also co-authored Nursing Homes: Getting Good Care There and Using Resident Assessment and Care Planning. A Guide for Ombudsmen and Other Advocates.

Burger is keeping the pressure on. Adequate staffing is high on her list of priorities. "We think there ought to be staffing ratios," she says. "That's the place the industry can save money the most easily."

Being a gadfly has produced other results. Burger has, for example, been working with the FDA and various organizations on the issue of bed rails. "We fussed and fussed," she says. "The statement recently written on the subject by the American Medical Directors Association reads as if the consumer were the most important person. I consider that an incredible change--a change that came about because consumers kept the issue in the forefront." And when you read the word "consumers," think Sarah Greene Burger. K. T. ANDERS

AFTER VICTOR REGNIER EARNED his architecture and engineering degrees, one of his teachers said that applying for an interdisciplinary aging fellowship at the University of Southern California's Andrus Gerontology Center would be a great career opportunity. Since taking his advice, Regnier literally has written the book-- or books--on long term care architectural design, shaping the industry in the process.

"I look at problems in two substantially different ways. It's the difference between theorizing and application. Mostly, I lecture on theory, but I can also implement and execute," he says.

And how. His career balances multiple perspectives and interests, winning accolades in every arena. He's the only person to achieve Fellowship in both the Gerontological Society of America and the American Institute of Architects. Hired to run the Andrus program he attended, he was enticed by the University of Illinois to hold the country's first joint professorships in architecture and gerontology, then recruited back to USC to do the same. From 1992 to 1996 he was Dean of the School of Architecture; he's won teaching awards, including USC's coveted MortarBoard Professor of the Year.

A man of theory and practice

Unlike most academics, he works often in his field, picking projects that offer opportunities to test theories or set precedents. He has consulted on program and design development for more than 250 projects in 28 states, Canada, and England; in the past three years, nine of his projects have won national design awards. As a researcher, he's directed 21 projects on social and behavioral environmental impacts on special populations including elders. His findings have been presented at 165 professional, scientific, and university conferences (and counting). His five books and numerous articles have won awards from the Fulbright Association, the American Planning Association, and the Gerontological Society of America.

In 1992, after receiving "the traveling European Fulbright award," Regnier researched 100 elder housing sites in five Northern European countries and shared what he learned in presentations and an award-winning 1994 assisted living book. "Northern Europeans are 15 years ahead of Americans, and they have evolved a lot of assisted living concepts," he says. "I wrote about what was happening and what we should be doing." Since studying 96 newly built European facilities, he's been updating that book, chronicling changes and future housing directions. He's also writing a design primer for ALFA University.

"Because my work involves analysis of design achievements of dozens of others, I write about concepts and approaches based on my experience as well as the experience of other architects," says Regnier. "The written work is often formatted to present design directives and implications, which make it easy for others to follow."

Regnier's designs strive to be both functional and beautiful. He believes design should optimize individuals; provide opportunities for social exchange; and maximize the quality of life for residents, their families, and caregivers.

"He's one of the seminal thinkers in long term care, and has done much to advance the cause of assisted living in the United States," says AAHSA president and CEO Len Fishman. "He obviously cares, he understands issues in an extraordinary way, and his unique background gives him stature. He's very adept at getting information and engaging interest. His work is fresh, vibrant, non-institutional, and just what's needed." BY WENDY BONIFAZI

DANIEL REINGOLD

Innovator raises the bar

HE DOESN'T MENTION HIS facility's museum-quality art collection, or its resident artist program, considered among the nation's best. He doesn't refer to board meetings and fundraisers equal to any great New York institution, attracting luminaries including Henry Kissinger and Barbara Walters. When he discusses first-in-the-nation achievements--ElderCare at Night (offering community respite care when it's most needed), resident-sensitive sexuality/intimacy guidelines, storefront geriatric services and clinics his facility offers jointly with hospitals, Ys, and senior centers--he quickly credits others.

"My best practice is developing leadership and creativity among staff members," says Dan Reingold, MSW, JD, executive vice president of The Hebrew Home for The Aged at Riverdale, N.Y. "Nobody can be creative and innovative by himself."

His staff is composed of 84 nationalities, but embracing diversity is old news for Reingold. Name any recent industry initiative and Reingold has already addressed it. Elder abuse? He's provided seminars and funding for years, recruiting district attorneys to train everyone from members of law enforcement to bankers, store owners, building supervisors, and letter carriers in identifying and reporting neglect and abuse. Want to talk about research? The Hebrew Home has its own institute. How about housing? Reingold's facility includes all levels, including NYC's first not-for-profit ALF.

Then there are intergenerational programs. Proclaiming that "children should be here all day, every day," Reingold started Project HOPE, "Healthcare Offers Permanent Employment," an on-site high school that pays at-risk students to work part-time in the facility, and guarantees them full-time employment after they graduate. Its graduation rate is 98 percent--three times the norm in the United States. "Nothing is as important as teaching children, one-to-one, to embrace and accept elders. Raising children to understand the needs of elders is something to be proud of," he says.

Ingrained to help at an early age

Reingold learned this lesson at family meals with his parents, both trained social workers. He spent Sundays and school holidays visiting residents at the Hebrew Home where his father, Jacob, held the position of administrator for four decades. At 12, Reingold wanted to grow up to be a nursing home administrator. Today, Reingold's three daughters continue the tradition of weekly visits with residents.

After earning an MSW from Columbia University and a JD from Yeshiva University, he landed a job with a prestigious New York law firm that represented not-for-profits. Then Reingold achieved his dream. The Hebrew Home's board asked him to work with--then succeed--his father. "It was a wonderful, wonderful mentor/student partnership," says Reingold of their decade together.

Reingold's three-word mantra is Create, Collaborate, Disseminate. "Creative ideas happen daily. My job is presenting challenges, asking questions, and making things happen," he says. "We look for partners, then share how-tos and problems internationally so others can re-create and improve on our successes."

Reingold's impact on the industry and on public perceptions is extraordinary, says Len Fishman, president and CEO of the American Association of Homes and Services for the Aging. "With his gifts he could have high-status and a lucrative law practice, but he loves this field and considers it the most fulfilling work he could do," says Fishman. "He has a direct, very beneficial effect on residents and staff members. He thinks beyond conventional limits, isn't intimidated, and is incredibly innovative. He's challenged conceptions, established extensive outreach services, recruited a breathtaking level of community support, and raised the standards of what nursing homes can be."

WENDY BONIFAZI

KEITH WEIKEL, PhD

A man for our time

HE TENDS TO GIVE CREDIT FOR HIS ACCOMplishments to others, but industry leaders and experts says that Keith Weikel, PhD, senior vice president, and COO of Manor Care Inc., is a heck of a guy. "He's a visionary who is always painting the picture of where we're going and instilling the belief that no matter how big the goal or how ominous the barriers, somehow we have what it takes to make it," says Susan Hines, vice president of medical specialty programs for HCR Manor Care.

Weikel is not only the number-two man at the most highly respected company in the nursing home industry, he is a mover and shaker in industry organizations and a vocal advocate on Capitol Hill. He served as vice president of the American Health Care Association (AHCA), and for 15 years served on AHCA's multi-facility committee, where he aligned the largest providers in the industry around common strategies and programs.

Co-founder of the Alliance for Quality, an action-oriented group of providers that works with AHCA, Weikel has helped orchestrate industry response to the rapidly changing legislation from Washington during the past few years. "The Alliance was able to mobilize quickly, raise capital, and develop and implement a campaign faster than the traditional mechanisms were able to do," says Stephen Guillard, CEO and president of Harborside Healthcare, who Serves with Weikel on the Alliance.

"One of the things we worked on specifically this year," says Weikel, "was to get more members of Congress to visit nursing centers. We generated about 20,000 phone calls, e-mails, and faxes to members of Congress. I believe that type of advocacy has had a greater impact than anything else that I did in Washington."

A role model of leadership

It is Weikel's leadership style that many find so admirable. "He translates visibility into respect and recognition into results," says Guillard. "He separates out the emotional baggage and approaches issues in a thoughtful yet provocative way."

Weikel's background in government gives him a unique perspective as a long term care advocate. "I understand the inner workings of the bureaucracy in its best and worst ways," he says. As administrator of the Medical Services Administration in the Department of Health & Human Services from 1974 to 1978, he had responsibility for the Medicaid program and was involved in establishing the Health Care Financing Administration. His awards include special citations for contributions to the management of the Medicaid program and for fraud and abuse initiatives. Congress appointed him commissioner of the Prospective Payment Commission from 1983 to 1986.

Quality is practically an obsession. "In addition to reimbursement issues, I'm every bit as interested in quality of care issues," says Weikel. "We attempted to differentiate Manor Care as a company by focusing on delivering high-quality clinical care but also delivering the quality of caring. I believe in health care today. But sometimes you get high-quality medical care in a non-caring environment." It's no wonder Bane of America Securities rates HCR Manor Care as the top nursing home chain in the country.

"Weikel is one of the best strategists in the industry," says Guillard. "He's one of the vocal people out there who not only believes in, but is advancing, programs of quality and emphasizing the advancement of quality both within his own company and within the industry." BY K. T. ANDERS

BOB WILLIAMS

A voice for change

WHEN BOB WILLIAMS TALKS, PEOPLE listen. The expert and advocate of community-based support for people with disabilities has been heard by everyone from providers to U.S. presidents--even when they have had to literally look over his shoulder as he painstakingly spelled out his thoughts on a letter-board. Today, his typed messages are converted to speech--and as deputy assistant secretary for disability, aging, and long term care policy in Health and Human Services' office of the assistant secretary for planning and evaluation, he's heard throughout the administration.

Appointed by President Clinton and HHS Secretary Donna Shalala, (who threw him a surprise birthday party last year), Williams is responsible for developing, analyzing, and coordinating HHS policies and programs supporting the independence, productivity, health, and long term care needs of children, adults, and older persons with disabilities.

"Before placing people into institutional settings, we need a clear understanding why that's most appropriate for that individual and, where possible, plans for transitioning back to communities," says Williams, himself born with cerebral palsy. "There is a continuing need for nursing homes and similar facilities. It's vital, though, that we use them for what they are best at providing."

Mr. Williams goes to Washington

Williams first went to Washington as a high school junior, hoping the month-long internship with his representative would enhance his education and employment opportunities. After earning an urban affairs degree from George Washington University, he served on the U.S. Senate Subcommittee on the Handicapped, analyzing the impact of the Reagan administration's weakening of civil rights protection. He worked for the District of Columbia Association of Retarded Citizens, monitoring closure of an institution for people with severe disabilities and developing alternative community services.

He spearheaded the United Cerebral Palsy Association's advocacy efforts on behalf of the Americans with Disabilities Act, working the Hill daily to educate legislators on barriers and opportunities. From 1993 to 1997, as commissioner of the administration on developmental disabilities, he promoted community inclusion policies.

"Getting people to collaborate is his most important skill," says Paul Marchand, governmental affairs director for The Arc of the United States (formerly the Association for Retarded Citizens). "He shone brightest in the late '80s [helping] to pass the ADA into law. He articulates positions, defines strategy, and knows the targets, messages, and messengers to get the job done. Despite frustrations with the Republican Congress' lack of new legislation, his legacy will be his having pressed for new federal thinking toward community-based services."

Williams is now sorting out the implications of the ADA for long term care with state Medicaid directors and disabled and aging constituents. "States must take reasonable steps to ensure that people with disabilities receive services in the most integrated setting appropriate," Williams says.

Another goal is getting states, service providers, and participants to discuss solutions to their common need for choice and control of services. With HCFA, his office recently funded the Resource Network on Home and Community Based Services.

Despite difficulties addressing both sets of concerns, Williams is optimistic. "It gets back to what my mom always said," he says. "You need to try and achieve those things others fail to see as possibility." BY WENDY BONIFAZI

Wendy L. Bonifazi, RN, and K.T. Anders are contributing writers to Contemporary long Term Care.