The technical assistance programs in Florida and Washington, which emphasized regulatory compliance issues more than the programs in other states, provided only a limited amount of direct consultation to nursing homes. Florida's quality monitors are deliberately careful to keep suggestions very general, forcing the facility to select the processes they feel are most appropriate to the needs of their residents. In Washington, technical assistance staff advise facilities to network with one another, but they avoid telling facilities how to fix problems. Reasons for the limited consultation provided in these states include (1) avoiding the danger of facilities being cited for doing something technical assistance staff told them to do; (2) limiting the potential liability of the technical assistance program for any advice they may give; (3) Federal restrictions on the types of consultation that can be provided as part of the survey and certification process; and (4) in Washington's case, preserving the perception that they are not providing "technical assistance" in order to maintain eligibility for federal funding.
In Maine, Missouri, and Texas, where the explicit intent is provision of direct consultation with facilities that is unrelated to regulatory issues, technical assistance staff appear to be comfortable sharing advice with facilities on how to treat particular conditions and individual residents. The Maine technical assistance nurse actually drafts care plans for inclusion in the medical record. Missouri technical assistance staff bring along many resource materials to the facilities they visit and provide guidance on a variety of topics. Texas technical assistance staff disseminate evidence-based best practice guidelines. Stakeholders in these states told us they greatly value the types of direct consultation provided under these technical assistance programs.