State Nursing Home Quality Improvement Programs: Site Visit and Synthesis Report. Positive and Negative Responses


In general, the response to the quality award programs has been positive. State nursing home regulators assert that the awards provide facilities with incentives to focus on quality improvement and create a benchmark for others to strive to meet. Providers, who appreciate any program that rewards good facilities, see the awards as a powerful marketing tool that can boost revenues and possibly reduce liability insurance costs. Advocates welcome any type of information that can help consumers make informed decisions about nursing home placement.

However, a number of concerns were also voiced about the award programs:

  • Early in the process, issues about the composition of the award panels were brought up either by providers concerned about conflict of interest, or by consumer advocates who felt under-represented. These issues needed to be dealt with before the panels could effectively operate. The states now report those concerns have been addressed, but there are still complaints in Florida that the process of selecting facilities is not completely unbiased.

  • In Florida, providers believe that the criteria for a financial audit are so restrictive that they practically eliminate the majority of facilities. They said small, independent homes, in particular, were effectively eliminated because they could not afford to submit independently audited financial statements, which can cost thousands of dollars. Advocates and state regulatory staff remained adamant, however, that the financial requirements are crucial for determining a facility's ability to provide quality care to residents.

    Some stakeholders expressed the idea that some eligible providers do not even apply, since the criteria are so stringent and the rewards so limited. For example, providers in Florida complained that the application process was very burdensome and lacked valued incentives such as an extended survey cycle, immunity from lawsuits, or increased reimbursement.

  • Some stakeholders questioned whether the criteria used effectively measure quality of nursing home care. Some expressed concern that the criteria actually excluded some of the best homes, while others believe nursing homes that provide only mediocre resident care were considered candidates. In Iowa, these concerns gained force when some facilities awarded the Governor's Quality Awards subsequently had problems on later surveys, and this resulted in bad publicity for the facilities, the state, and the program. In addition stakeholders in Iowa expressed concern that its Deficiency Free Certificates of Recognition also gives a false sense of security to consumers.

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