State Nursing Home Quality Improvement Programs: Site Visit and Synthesis Report. 4.4 Facility Recognition Programs

05/15/2003

Two of the states we studied (Florida and Iowa) have developed and initiated reward and recognition programs as part of their quality improvement efforts. The goal of these programs is to recognize facilities doing exemplary work. Examples of Facility Recognition Programs can be found in Appendix F.

Florida and Iowa use a similar process for selecting facilities for quality awards. Residents, family members, members of resident advocacy committees, or other health care facilities can make nominations for the awards. In Florida, nominations can be also made by the state Agency for Health Care Administration, provider organizations, ombudsman, or any member of the community. Nominations are presented to a governor-appointed committee that includes the state's long-term care ombudsmen and other consumer advocates, and health care provider and direct care worker representatives. Both states make efforts to eliminate conflict of interest among committee members.

Both states specify criteria that must be met for a provider to receive a "recognition" award. Nominees must provide a description of the facility's best practices and the resulting positive resident outcomes, or the unique or special care or services (nursing care, personal care, rehabilitative or social services) provided by the facility to enhance the quality of life for its residents. Performance data (e.g., the facility's "report card" or assigned "quality of care rank" within the applicant's geographic region) are used in determining the facility's quality.

Florida facilities must meet a number of additional rigorous criteria to qualify for the quality award including: strict standards of performance on survey inspection results (i.e., no Class I or Class II deficiencies within the previous 30 months of application), no history of complaints, high level of family involvement, satisfied consumers as measured by an assessment of consumer satisfaction, low staff turnover rates, and the provision of in-service training. Further, facilities are required to demonstrate financial soundness as evidenced by a formal financial audit. Many stakeholders believe that this latter criterion eliminates most facilities from consideration because most facilities may unable to afford such an audit and providers that have been the subject of bankruptcy proceedings (or whose parent organization have been the subject of bankruptcy proceedings) during the preceding 30 months are disqualified.

In both states, following selection of the finalists by the awards panel, onsite reviews are made to verify the accuracy of the information on the nomination form. When the awards are confirmed, the governor presents a certificate to the facility administrator in a recognition ceremony. Some consideration has been given to providing additional rewards to award-winning facilities, such as an extended survey cycle, but these have not been implemented due to federal policies mandating that nursing facilities be surveyed every 12 to 15 months.

Despite Florida's more detailed and complex requirements for consideration, a similar percentage of facilities in both states (between one and two percent) have received the quality awards. Iowa's numbers are limited because the state legislation permits only two facilities from each congressional district to be recognized as award winners each year.

In addition to the quality award described above, Iowa also presents a Certificate of Recognition to any facility that receives a deficiency-free survey. The certificate is intended to acknowledge the "hard work and dedication" of the facility's staff in meeting the established standards of care, and is considered a way of providing positive feedback to providers with good survey results.

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