Maine was selected for a site visit because it met the criteria established by the research team and Technical Advisory Group in that it has established and funded quality improvement programs, which are not reimbursement related. Researchers were particularly interested in Maine because of the unique technical assistance component within the quality improvement programs. Maine's technical assistance program, in existence since 1994, consists of one nurse who provides consultation and educational inservices statewide to any long term care facility on problem resident behaviors. The Technical Advisory Group believed that Maine's small technical assistance program might serve as a model to other states that were interested in providing technical assistance to nursing facilities but not able to implement a large-scale program. The State also recently enacted legislation that mandated a Best Practices Program, a consumer satisfaction survey and measures to significantly increase their minimum nurse staffing ratios.
Abt staff members Donna Hurd and Leighna Kim spent one day in Augusta, Maine on September 12, 2002. The following individuals agreed to participate in in-person and telephone discussions with the researchers:
- Division of Licensing and Certification, Bureau of Medical Services
- Laura Cote RN, Long Term Care Behavior Management Consultant
- Diane Jones RN, Assistant Director
- Long-Term Care Ombudsman Program, Bureau of Adult and Elder Services
- Brenda Gallant RN, State Long Term Care Ombudsman
- Catherine Valcourt, Legal Counsel
- Maine Health Care Association
- Nadine Grasso, Director of Communications
- For-Profit, Multi-Nursing Chain Facility--65 Beds
- Assistant Director of Nursing
- For-Profit Partnership, Multi-Facility Chain Facility--62 Beds
- For Profit, Independently Owned Facility--60 Beds
- State Representative
- Thomas J. Kane, Ph.D., Chairman of the Health and Human Services Committee
Laura Cote and Brenda Gallant were the primary contacts for our Maine visit. Ms. Cote and her supervisor, Diane Jones participated in both in-person and telephone discussions. Ms. Cote also provided written information about the behavioral consulting program and a list of directors of nursing who would be willing to speak with us about her services. Ms. Gallant and Ms. Grasso were helpful in providing information on the quality improvement programs enacted as part of the April 2000 omnibus legislation. Ms. Gallant provided copies of the final legislation. Dr. Kane provided valuable information on the development of the legislation.
Prior to the on-site visit, factual information on the quality improvement program was gathered from a literature review, stakeholder discussions and Maine Department of Human Services web site. Information on the following aspects of the programs was gathered and organized in a table:
- Program title;
- Program description;
- Agency contact--the person(s) most knowledgeable about the program protocols and implementation to date;
- Impetus--what prompted the development of the program;
- Designer--identify the individual(s) or group(s) responsible for program design and indicate agency affiliation(s);
- Goals--state the program objectives;
- Funding Source and Amount--state current funding amounts/sources and projections for future periods;
- Program Staff--indicate how many individuals are involved in the program implementation including administrative support, what is the organizational structure;
- Facility Involvement--is this a requirement for all facilities or a voluntary program, how are facilities selected for inclusion, if voluntary?
- Dates--what are the program beginning and end dates; and
- Evaluation--indicate current and planned formal evaluation program(s).
The research team used the factual information in the tables as a starting point to develop discussion questions that focused on more in-depth issues. Letters of endorsement explaining the project goals, state selection and discussion processes were formulated and sent to prospective participants. Follow-up phone calls were made to arrange for convenient dates and times for meetings.
Discussions with Ms. Jones and Ms. Gallant took place at their offices. Ms. Cote, who works from her home, met with the researchers at the Division of Licensing and Certification offices. These meetings lasted from one to two hours. Discussions were generally loosely structured with researchers presenting both prepared and spontaneous questions and recording participants' responses in writing.
Follow-up calls were made with two directors of nursing and one assistant director of nursing of the facilities that Ms. Cote recommended, the Director of Communications at the Maine Health Care Association, and Thomas Kane, the state legislator who chairs the Health and Human Services Committee.