State Nursing Home Quality Improvement Programs: Site Visit and Synthesis Report. Quality of Care Monitoring Program


In 1999, HB1971 established the Nursing Home Quality of Care Monitoring Program. It was designed to "create a positive partnership between the Agency and nursing homes and ultimately yield improved quality of care to residents". Initially the legislation called for yearly visits for monitoring of all facilities and quarterly for troubled facilities. The program is funded primarily by general revenue, with some matching federal funds.

SB 1202 increased the number of monitors from 13 to 19 and mandated quarterly visits to all facilities, with additional visits based on high-risk factors. Nursing homes that have been on the Nursing Home Watch List have the highest priority. Second priority facilities are those that have a combination of the following: A history of non-compliance or "yo-yo" compliance; nursing homes that upon analysis of quality indicator reports reflect potential weaknesses; nursing homes that have either changed ownership, changed administrators or changed Director of Nursing Services recently; and all new facilities.

Quality of Care Monitors must be registered nurses licensed in Florida, preferably with surveyor experience, and be Surveyor Minimum Qualifications Test (SMQT) qualified. Each monitor has a caseload of approximately 30 facilities assigned within a geographic area and each consults with other monitors on their area team who have particular areas of expertise.

Quality of Care Monitoring visits generally include touring the facility, observing residents and care providers in a variety of settings, as well as interviewing key staff, residents, and family who are present. They were originally mandated to be unannounced, but this is no longer adhered to when risk management duties require meeting with the facility risk manager. The visit may last anywhere from three hours to two days depending on the size of the facility and what a monitor finds. During visits, monitors seek to identify, at an early stage, any conditions that are potentially detrimental to the health, safety, and welfare of nursing home residents. Monitors may opt to identify a particular issue to focus on for a visit and not may discuss every triggered quality indicator. They may also opt to focus on an issue that the facility has identified as a problem.

Monitors are careful not to endorse a particular process--they can provide guidance and references, but the process has to be one that the facility identifies. They explained that their suggestions are very general. They are careful not to say, "Do it this way". They try "to keep the onus on the facility." They state that the facility must adapt the process to meet the needs of their residents. They offer educational resources and performance intervention models designed to improve care including materials available to share with facilities such as journal articles, websites and various protocols. They share information about good practices they have seen in other facilities. Monitors also interpret and clarify state and federal rules and regulations governing the facilities.

At the conclusion of each visit, the Quality of Care Monitor and the facility administrator meet to discuss findings. The administrator is advised that a written summary will follow, but that it's not to be construed as evidence of compliance or non-compliance. A copy is kept on file with the Agency and one is given to the nursing home so both can track progress. While the focus of the program is early detection, mandatory reporting of conditions which threaten the health or safety of a resident is required. Any such findings are officially reported to the Agency for regulatory action and, as appropriate or required by law, to law enforcement, adult protective services or other responsible agencies.

Since May 2002, monitors have also been given the responsibility to assess the operations of internal quality improvement, risk management programs and adverse incident reports. In addition, the Quality of Care Monitors collaborate and coordinate with the Field Office Managers in visiting facilities that are being financially monitored, closing, or in immediate jeopardy, to ensure the health and safety of residents. Monitors attend survey field office staff meetings and coordinate with the field office staff during a jeopardy situation. They also assist with training new surveyors.

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