Another area of consensus across all six states was the need to pay more attention to quality of care issues generally, and staffing issues specifically. To increase the recruitment and retention of direct care staff, many respondents noted a need for better pay and benefits, more training, career ladders, improved management, and better work environments.
In light of the older ages, higher levels of impairment, and chronic health conditions characteristic of residential care residents, several noted the need to increase both the quantity and quality of health and nursing services provided in residential care settings. However, one person in Oregon cautioned that what was needed was not more direct nursing services, but more nursing being taught and appropriately delegated.
Two respondents noted that more research is needed to help develop systems that assure quality in residential care settings that do not have nursing services available 24 hours a day. In particular, more information is needed to develop effective training for medication administration and management, and to identify methods to teach unlicensed personnel about disease management.
Several said that more outcome-oriented regulations would better assure quality, and that comprehensive standardized assessment instruments tied to quality indicators would help providers identify areas where improvement was needed. A number suggested a quality assurance approach that focused on identifying and fixing problems.
In Wisconsin, many said that the state needed to do a much better job of overseeing residential care settings, particularly Residential Care Apartment Complexes, and that greater enforcement of the state's regulations were needed. At the same time, they acknowledged that scarce resources were responsible for the state's falling short on enforcement.