During the case studies we asked stakeholders if there were any suggestions they wished to offer the Federal Government with respect to nursing home quality improvement. The comments we received applied to perceived federally imposed barriers to state-initiated quality improvement programs, and to federal policies related to regulation, staffing, and quality.
In general, the states said they wanted to improve their relationships with the Federal Government. Officials in one state described the relationship between CMS and the state as "hostile." Providers in that state were especially upset by their belief that a deficiency-free state survey often triggered a federal survey. They encouraged the Federal Government to implement a policy that rewards good nursing homes with less frequent surveys and to focus resources on poorly performing facilities. Officials in another state said the Federal Government should be more flexible in allowing states to be innovative and to make their own attempts to improve quality. Stakeholders across states expressed a desire to either implement or expand technical assistance programs or other quality improvement initiatives--but believe that federal funds for such initiatives needs to be expanded.