Initial discussions were held with program administrators, then with a set of QANs at the central program office. Additional discussions were held with Ombudsmen (at their office) and with a set of providers at each of the two key nursing home associations. These meetings each lasted approximately two hours. In addition, research staff accompanied a QAN on a regularly scheduled visit to a home. Finally, research staff attended a meeting (at a nursing facility) of the Board of the Resident Councils of Washington and had the opportunity to discuss the QAN program with participants.