State Nursing Home Quality Improvement Programs: Site Visit and Synthesis Report. Participants


Abt staff member Christine Hale and consultant Barbara Manard were responsible for the site visit. Over a four-day visit in August 2002, the research team met with individuals involved in the development and operation of relevant programs; held roundtable discussions with 5 providers (who had recently experienced a Quality Monitor visit) at each of the two major provider associations; spoke with representatives and staff from two consumer-oriented organization; and attended a half-day training program for Quality Monitors during which the research staff talked informally with approximately 10 quality monitors. Formal discussions were held with the following people.

  • The Texas Department of Human Services
    • Bettye Mitchell, Deputy Commissioner for Long Term Care
    • Evelyn Delgado, Assistant Deputy Commissioner for Long-Term Care Regulatory
    • Leslie Cortes, MD, Director of Medical Quality Assurance
    • Jim Lehrmen LMSW-AP, former Deputy Commission for Long-Term Care Regulatory,
    • Deirdre Monroe, RPh, PhD, Pharmacy and Nutrition Manager (the Quality Monitor program)
    • Benjy Green, Administrative Management (budget and finance)
    • Hilda Mikan, RN, BSN, Nurse Manager for the Quality Monitor Program
  • Texas Health Care Association (THCA)
    • Tim Graves, President
    • Robin Hayes, Director of Best Practices
    • Roundtable discussion participants:
      • An administrator from a 118 bed facility, 20 bed dementia, 40 bed traditional LTC, 60 shot-stay rehabilitation, 15-20 patient outpatient rehabilitation with a 95 percent occupancy rating.
      • An administrator from a 117-licensed bed dually certified general nursing facility.
      • An Assistant Director of Nursing from a 147 bed facility
  • Texas Association of Homes and Services for the Aging (TAHSA)
    • Roundtable discussion participants:
      • Rose Ireland, RN (TAHSA staff person with particular expertise in quality issues)
      • An Executive Director from a not-for-profit 65 Continuing Care Retirement Community Nursing Facility with an 18-bed dementia unit with a 99 percent occupancy rate.
      • An Executive Director and Director of Nursing from a skilled nursing facility with 120 beds with no special levels with a 97 percent occupancy rate.
  • Texas Advocates for Nursing Home Residents
    • Beth Ferris, Legislative Representative
  • Texas Department on Aging
    • John Willis, LMSW-ACP, State Nursing Home Ombudsman
    • Cheryl Cordell, Ombudsman Specialist
    • Ola Kidd, Assistant State Long-Term Care Ombudsman

Leslie Cortes, the Director of Medical Quality Assurance, was the primary contact for the Texas site visit. Dr. Cortes oversees most of the quality improvement initiatives discussed below. He is a geriatrician with substantial experience in computer systems and health care quality issues and was responsible for the detailed design and implementation of the Quality Monitor program and several other initiatives discussed below. There were personnel changes in two key positions just prior to our visit. Bettye Mitchell became the new Deputy Commissioner for Long Term Care at the Department of Human Services (DHS) effective July 15, 2002. Evelyn Delgato had just replaced Jim Lehrman who was the Assistant Deputy Commissioner for Long Term Care Regulatory (the agency responsible for the survey and for two initiatives discussed below) for the past five years.

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