The technical assistance component of Maine's quality improvement programs began in 1994, prompted by the closure of a nursing facility whose population was made up primarily of residents with major psychiatric diagnoses and problem behaviors. The 50-bed facility had accepted residents that other facilities would not admit and experienced significant resident-to-resident and resident-to-staff abuse. When the decision was made that the facility would close because of state and federal regulatory violations, a transition team was assembled. Laura Cote, who had been the psychiatric liaison at the facility as well as the resident care coordinator and the staff development coordinator, was recruited as a member of the transition team. Ms. Cote followed the residents as they were evaluated and placed at new facilities between February and June 1994. She worked closely with the accepting facilities (40 in Maine and 1 in Massachusetts) to teach staff about each resident and his/her behavioral issues, assist them in understanding the issues, and to develop a care plan. At the end of the transition period, the Director of the Bureau of Medical Services asked if Ms. Cote would expand her work to provide consultative assistance on problem behaviors to all long term care facilities in the state. Working first as a consultant and then as a state employee within the Licensing and Certification Department, she continues to provide both consultative services and inservice programs for all long-term facilities in Maine.
Cote explained that while participating in the closure of the facility, she recognized that educational programs available to long term care staff were generally held outside the facility, requiring that a representative of the facility attend the program and carry the information back to the staff. She envisioned a program that would more effectively provide educational and support services in the environment of the residents and the direct care staff. She aimed to equally divide her efforts between educational training and consultation. Consultation is primarily directed at assisting staff to understand and manage resident behavior, rather than counseling or treating residents.