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


Maine's quality improvement programs consist of the long-standing but limited behavioral consultation and the recently enacted educational and staffing requirements. Both programs have limitations--the technical assistance is very limited in scope and focus and the Best Practices and minimum staffing requirements have been underway for just one year. The programs, however, include distinct features in their development and continuing processes that distinguish them from other states and which could serve as valuable models to other states.

The technical assistance program involves one nurse providing behavioral consultation statewide to any long-term facility upon request. Its success in improving resident outcomes through a combination of consultative and educational support is apparent, although not formally proven. On a small scale it demonstrates the value of an individual facility/resident approach, the need to involve all staff in care planning and problem solving, and the benefits of distancing technical assistance from enforcement activities and of providing education that is tailored to the direct care staff.

Although only two Best Practices workshops have been presented, one of them utilized a unique approach of incorporating information on regulatory compliance with practical implementation guidance. A surveyor provided interpretation of regulations followed by a panel discussion/presentations by facilities that had submitted best practices around a particular clinical area. This combination of reporting enforcement interpretation and successful clinical outcomes captured the attention and interest of administration and clinical staff with subsequent changes in policy and care planning.

Lastly, the manner in which the legislation covering the quality improvement programs was written was an attempt by the legislature to first identify guiding principles and goals and then use them to develop a targeted approach to accomplish the goals, rather than reacting to isolated issues. The development of a framework for how the Maine long-term care system should operate and the identification of key principles to guide public policy decisions on long-term care was seen as a novel approach. It remains to be seen how and to what degree these principles will impact future long-term care legislation.

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