A coalition of provider and consumer groups has released an outline of a quality monitoring and improvement initiative that already has prompted a dispute with another nursing home group.
The report of the Assisted Living Quality Coalition-which comprises the American Association of Homes and Services for the Aging, the American Association of Retired Persons, the Assisted Living Federation of America and the Alzheimer's Association-contains guidelines for minimum quality standards and establishes a framework for quality monitoring and improvement.
The coalition said the release of the outline marks the first time consumer and provider groups have developed a framework for monitoring and improving quality in the assisted-living community. The four groups signed a memorandum of understanding affirming their support of the outline.
But the direction of the quality project already has caused a rift in the long-term-care community.
The American Health Care Association, which represents 11,000 for-profit and not-for-profit nursing homes, had participated in the early development of the quality initiative but parted with the coalition because it felt the initiative was too oriented toward government-enforced regulation (July 15, p. 27). The AAHSA, the other nursing home trade group involved in development of the initiative, represents 5,000 not-for-profit facilities.
But the coalition's report argues that its quality guidelines are "more flexible and less prescriptive" than most regulations because it calls for a monitoring system based on outcomes rather than regulatory compliance.
To ensure that the recommendations become the assisted-living community's standards, the coalition is calling for a credible independent body to follow through on many of its recommendations, including development of state licensure standards, development of quality indicators, and research and data collection.
The coalition's basic quality framework calls for minimum standards that assisted-living facilities must meet, state licensure, quality monitoring and improvement, and state enforcement when deficiencies persist or immediate threats to the health and safety of residents are identified.
To implement the quality standards, the coalition's report calls for development of guidelines for state enforcement standards, development of quality indicators, research and data collection on outcomes and practices that will lead to improved outcomes, monitoring of outcomes, and consultation with facilities in which problems have been identified.
The coalition also calls for facilities to monitor compliance with minimum standards, monitor clinical and functional quality indicators, and attend to feedback from residents and their families on how to improve quality. When any deficiencies are discovered, the coalition says internal quality improvement teams should develop an action plan. The coalition calls on state regulators to assist in developing those action plans by being less adversarial and acting more like consultants.