There was a general consensus among those interviewed that it is to early to determine what impact, if any, the quality improvement activities undertaken in Texas will have on quality of care and quality of life in nursing homes. One consumer representative noted that in her view the new program was likely to have a marginal effect relative to the improvement in quality that might be realized were the state to mandate increased staffing. Some providers said that higher reimbursement rates would be a better lever to improve quality. The Ombudsman, by contrast, noted that the program was focusing on some areas that are very important to resident life and care and that changing practices in those areas would by definition positively affect quality.
The question that naturally arises is the degree to which the program will be able to actually stimulate sustained changes in practices. Among the five facilities that had had a Quality Monitor visit and subsequently participated in discussions with the research staff, one cited an actual change in practice attributable in part to the Quality Monitor visit that reduced restraint use; one stated firmly that the program would have absolutely no effect; and the others fell somewhere in between, with more tending towards the less enthusiastic side. Quality Monitor staff with whom informal discussions were held at a half-day training program could each cite some instances where providers thanked them for assistance provided and appeared to have been inspired to implement some new practices. However, those same staff estimated that as many as four out of ten of the facilities visited in the early stages of the program were at best neutral, and sometimes hostile, regarding the new program. Those anecdotes present a picture of the range of possible responses to the new program. As noted above, a quantitative evaluation of actual changes in quality as defined in the program is planned as part of the next Statewide Quality Review.