State Nursing Home Quality Improvement Programs: Site Visit and Synthesis Report. Aspects of Maine's Quality Improvement Programs Noted to Work Well


The Behavioral Consultation offered in Maine is well received partially because although organizationally housed within the Division of Licensing and Certification, it is completely separate from regulatory activities and because there is no cost involved for facilities. Contributing equally to the program's effectiveness is the experience and qualifications of the individual who is solely responsible for it's structure and content. Laura Cote is seen as knowledgeable, credible, familiar with the long-term care environment and able to communicate well with both licensed and unlicensed staff. Because Ms. Cote works from her home, facility staff were often not aware that technically she works within the Division of Licensing and Certification.

Participants were unanimous that Ms. Cote's consultation was helpful not only to residents but to staff as well. One director of nursing stated that by soliciting staff input, particularly from nursing assistants that Ms. Cote was able to diffuse difficult situations that could potentially lead to physical and/or verbal abuse. Ms. Cote has a reputation of being able to glean from a record relevant care information that staff had either missed or considered insignificant. Another nursing director noted that even though the problem behaviors often could not be eliminated, the discussion around them gave all levels of staff, the nursing assistants in particular, insight as to why these behaviors were occurring and support to continue their efforts at dealing with them. The separation from the surveyors makes the facility staff feel comfortable interacting with Ms. Cote. One director of nursing noted that often their record of having consulted with Ms. Cote improved survey outcomes as it demonstrated to the surveyors that the facility was taking appropriate action to improve certain problematic situations. Providers noted that the careplans that Ms. Cote develops and leaves with the facility were organized, detailed and very useful, but emphasized that the process of speaking with (and listening to) staff was an equally important part of her service.

The inservice programs that Ms. Cote offers were noted to be well attended, to the degree that facility staff came in on their days off so as not to miss them. Nursing directors explained that Ms. Cote's presentations are "down to earth," and appropriate for all staff. The programs include many examples from Ms. Cote's own experience that staff are able to relate to and learn from.

Providers also praised the Best Practices workshops and hoped that additional ones would be planned. The panel discussion that occurred as part of the Nutrition and Hydration workshop was noted to be particularly helpful. One nursing director stated that their facility had initiated some new approaches to dining after attending that workshop and had adopted some of the ideas into their quality improvement program.

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