Developing a residential care facility version of the observable indicators of Nursing Home Care Quality Instrument.

The last decade has seen a substantial growth in the development of residential care facilities (assisted living facilities). Evaluation of the quality of care in this service delivery sector has been hampered by the lack of a consensus definition of quality and the lack of reliable instruments to measure quality. Founded on extensive research on nursing home care quality, a field test of the Residential Care Facility Version of the Observable Indicators of Nursing Home Care Quality Instrument was conducted in 35 residential care facilities in Missouri. Content validity of the 34 items was rated by 4 expert raters as 3.4 on a 4-point scale of relevance. Test-retest was 0.94, interrater reliability was 0.73, and internal consistency was 0.90 for the total scale, indicating excellent results for initial field-testing. A focus group confirmed the 5 dimensions of quality of care measured by the instrument as important in residential care settings.

Getting the basics right. Care delivery in nursing homes.

In this study, the key exemplar processes of care in facilities with good resident outcomes were described. It follows that with description of these processes, it is feasible to teach facilities about the basics of care and the ways to systematically approach care so they can adopt these care processes and improve resident outcomes. However, for this to happen key organizational commitments must be in place for staff to consistently provide the basics of care. Nursing leadership must have a consistent presence over time, they must be champions of using team and group processes involving staff throughout the facility, and they must actively guide quality improvement processes. Administrative leadership must be present and express the expectation that high quality care is expected for residents, and that workers are expected to contribute to the quality improvement effort. If facilities are struggling with achieving average or poor resident outcomes, they must first make an effort to find nursing and administrative leaders who are willing to stay with the organization. These leaders must be skilled with team and group processes for decision-making and how to implement and use a quality improvement program to improve care. These leaders must be skilled at building employee relations and at retention strategies so residents are cared for by consistent staff who know them. The results of this study illustrate the simplicity of the basics of care that residents in nursing facilities need. The results also illustrate the complexity of the care processes and the organizational systems that must be in place to achieve good outcomes. Achieving these outcomes is the challenge facing those currently working in and leading nursing facilities.

Statewide strategy to improve quality of care in nursing facilities.

PURPOSE: We describe the development of a statewide strategy to improve resident outcomes in nursing facilities, and we present some evaluative data from this strategy. DESIGN AND METHODS: Key components of the strategy include (a) a partnership between the state agency responsible for the nursing home survey and certification and the school of nursing in an academic health sciences center; and (b) on-site clinical expert technical assistance and support to facilities throughout the state. RESULTS: The partnership has resulted in state agency staff having information from analyses about resident needs and outcomes in the state and facilities having access to the quarterly electronic "Show-Me Quality Indicator Report." On-site clinical expert technical assistance is now used widely across the state, with 569 site visits conducted in 286 different facilities to help them interpret their quality indicator (QI) reports and implement quality improvement programs; statewide improvements in QI scores have been measured in several key QIs. IMPLICATIONS: Other states should consider building partnerships with schools of nursing in an academic health sciences center. Programs using on-site clinical consultation can facilitate improving quality of care in nursing facilities.