In geriatric, long-term-care facilities, nursing assistants (NA) fulfill a primarily custodial function, and the manner in which they interact with patients can reinforce dependent behavior. If the goal of long-term-care is to progress from the custodial model to a therapeutic model of rehabilitation, the role of the NA must be redesigned. Effective training and management systems will be needed to teach new skills and to assure performance of these skills during daily work activities. This article reviews current methods of institutional staff training and management and proposes a model for geriatric, long-term-care facilities. Organizational resistance is discussed, and suggestions are made for enhancing cooperation.