Many respondents offered advice related to the structure and function of TA programs, particularly regarding the relationship between TA and survey. The majority of respondents reported that they believe the TA programs are worthwhile and have a positive impact on facility quality of care. However, they varied in their opinions regarding which facilities should be targeted to receive technical assistance. Some consumer advocates said TA programs should focus primarily on small independent facilities that have fewer of their own resources from which to draw. Other stakeholders thought TA programs should either be mandatory for all providers or should focus primarily on poor performers.
Strong, but by no means unanimous, opinions were expressed about whether states should maintain separation between their TA programs and their LTC survey and certification process. States that had preserved that separation felt strongly that it is critical to the fundamental purpose of TA--i.e., to help facilities improve the care they deliver. Stakeholders from both the state survey agencies and the TA programs holding this view emphasized that any blurring of the lines between survey and TA could cause providers to become skeptical about confidentiality, and to fear that information shared during TA sessions will be reported to surveyors. They felt that this lack of confidentiality has the potential to chill the relationship between technical assistance staff and facilities, resulting in a loss of candor on the part of facilities and, as a result, lost opportunities for TA assistance.
In contrast, most program staff and many providers that we talked to in states with closely tied TA/survey programs recommended that TA staff also function as surveyors for reasons that are discussed in section 3.2, namely that the association with survey causes TA staff to have greater authority, more regulatory knowledge, and therefore a better ability to effect positive changes in resident care.
In several states, respondents, representing both TA programs and facilities, stressed how important the quality and personality of TA staff is to the success of their efforts. To be effective, it was generally agreed, staff members should be experienced in long-term care and sufficiently flexible to work collaboratively with facility staff. It was also agreed that the standards used and the training given to TA staff must be consistent to avoid subjective consulting across facilities.