State Nursing Home Quality Improvement Programs: Site Visit and Synthesis Report. Sustainability and Lessons Learned


Participants did not indicate any plans to change the behavioral consultation visits, although some recommended that expanding the program would be advantageous. Current budget constraints limit any plans in this direction. The survey respondent stated that any additional funds would most likely to be used to hire more surveyors.

The legislative mandate that created the Best Practices program was not specific to the number of educational programs that were to be provided, except to state that the "Department of Human Services will participate in a series of best practices forums…" The survey respondent who headed up the program planned to reconvene the program's Task Force to begin planning future activities. Some ideas, although not firm were to investigate activities in this area in other states and/or possibly make Best Practices available in some sort of publication.

There was some discussion by participants to re-examine the minimum staffing requirement. Although all contacts voiced support for the principle of improved staffing, there were some thoughts of possibly modifying the language of the regulation to allow facility staff more latitude in managing the numbers. Proponents of the increased minimum ratios did not want to have to go back to the legislature to re-write the regulation, but rather were hoping for increased flexibility in the interpretation of the regulation in view of the current nursing labor shortage. Participants advised other states that funding passed to implement increased staffing should be proposed as ongoing and not limited to the year the measure was passed.

When questioned regarding recommendations for other states, participants enthusiastically advised that, "Every state should have a Laura Cote." One respondent cautioned, however, that every state is unique and what works in one state may not work in another. This comment addressed the fact that Ms. Cote works alone covering the whole state and that often facilities wait up to two weeks for a requested consultation. Facilities in Maine accepted the two-week wait for consultative visits, possibly because many of them are located in rural areas, and are accustomed to not having services readily available.

Participants advised that with any consultative or technical assistance program that the qualifications and experience of the hired consultants was critical. For behavioral consultations to be successful, they noted that a potential consultant needed to be well versed in clinical, psychiatric and long-term care issues. Because of the diversity of diagnoses present in the long term care population, being an expert in only one of the aforementioned areas would not be adequate to provide facilities with valid and useful information.

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