Performance Improvement 2004. State Nursing home quality improvement programs: site visit and synthesis report


The purpose of this study is to inform state and federal policymakers about state-initiated quality improvement programs for nursing home quality of care, with the goal of providing information to states that may wish to develop similar programs. Some states are using consultative, collaborative technical assistance (TA) programs in an effort to improve nursing home quality in addition to the traditional regulatory approach embedded in survey and enforcement processes. These TA programs allow the states to provide on-site consultation, training, and/or sharing of best practices in an effort to improve nursing home quality of care. Key stakeholders were contacted in seven states-- Florida, Iowa, Maine, Maryland, Missouri, Texas, and Washington—to gain information about states’ TA programs. The design and focus of TA programs varied across states, but shared several characteristics: the provision of on-site training and consultation with nursing facility staff; an emphasis on collaborative approaches between facilities and TA staff; a non-punitive approach that typically was not shared with the survey and certification agency unless serious violations were observed. The circumstances leading to a state’s decision to use a TA program were unique, yet the catalyst for the decision process was the same---the desire to “try something new” and provide a positive stimulus to quality improvement in addition to the long-term care survey process. The main findings from the study were: (1) that the relationship established between TA and survey program is a critical decision point for these states, (2) non- mandatory TA programs may not reach facilities most in need of help, but a non-mandatory program  may be the only option for some states with budget limitations, and (3) evaluation needs to be part of the initial program’s design, which is particularly difficult since states often implement several statewide programs simultaneously.

PIC ID: 8014
Agency Sponsor: ASPE-ODALTCP, Office of Disability, Aging, and Long-Term Care Policy
Federal Contact: Harvell, Jennie, 202-690-6443
Performer: Abt Associates Inc., Cambridge, MA

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