The principal reasons for selecting either an approach that emphasizes nursing home care practices or regulatory compliance appear to be primarily related to the stance of the state and the availability of federal funding for programs based in LTC regulation. Particularly in Washington State, there is a belief that the monitoring and enforcement of federal requirements for facilities can and does result in higher quality of care delivery. It is clear that many nursing facilities value technical assistance that is focused on improving survey outcomes, and that some value this type of assistance more than technical assistance directly focused on improved quality of care. There may be greater potential for conflict-of-interest for the programs with a regulatory focus, with TA staff who often work as part of the state survey agency, providing advice on issues related to regulatory compliance, but there are no data that permit determination of which type of approach is more effective in improving quality.
It is also the case that in states where technical assistance programs have a primarily regulatory focus, the distinction between technical assistance and LTC survey tends to become blurred. In Florida and Washington, for example, technical assistance staff occasionally act as surveyors, sometimes having to clarify with facilities as to which role they are playing on a particular day. This would seem to have an obvious impact on the type of information shared between facility and technical assistance staff, which can be expected to mute the effectiveness of any technical assistance whose intended focus is quality improvement outside the realm of regulation.