Hundreds of providers, consumers and government officials participated in CMS’ Open Door Forum about the proposed nursing home rating system yesterday. On the call, particpants discussed a variety of issues that will impact this system.  Many expressed concerned about the validity of using government survey data, which is based on minimal compliance levels, as the primary factor for determining quality.

Perhaps the most important news is that there’s still time to share your thoughts about this system and how  should be structured and managed. Thomas Hamilton, director of the nursing homes survey and certification group at CMS, is asking that individuals send in their comments by July 23 to  help regulators “make many decisions about the research that needs to be conducted fairly quickly.”

Please send your comments to us and to CMS as soon as possible.

Today, CMS will host an Open Door Forum at 2 p.m., Eastern Daylight Time about on the new five-star rating system they proposed last week. The ratings will be posted on the agency’s Nursing Home Compare Web site by the end of this year. However, during June and July 2008, the agency is soliciting ideas, comments and suggestions from the public, consumer groups, nursing homes and others.

This call is your opportunity to ask questions and offer suggestions about the system and advocate that  resident satisfaction data, nursing hours and staff turnover rates be included in it.  It is also a chance to ask CMS to detail how survey and certification data will be factored into the ratings. Click here for more information about the call.

To participate, please call (800) 837-1935 by 1:45 EDT and enter the conference ID: 50249977. You can also send your comments to us and to CMS. 

There’s seven weeks until AAHSA’s first Homecoming Week, and members are already starting their celebrations. In fact, The Marvin/Under One Roof, Inc. in Norwalk, Connecticut, even opened their doors to their community and legislators yesterday. This affordable housing community hosted an annual brunch to celebrate their residents and honor their work on the organization’s ”Blankets of Hope” service project. Everyone from Norwalk’s Mayor Richard Moccia to  their Congressman, Chris Shays (R-Conn.), joined them for this special event. Here’s some more information about it straight from The Marvin’s executive director, Mary Windt:

“The Marvin is celebrating its 11^th Anniversary with an Annual Family Brunch. This year, we are using this event to recognize and honor The Marvin Residents, who have completed 1000 Blankets for our wounded service personnel in the United States and Overseas. While the day is geared primarily towards The Marvin’s residents and their family members, there will be members of the Board of Directors, staff and some community representatives attending. It is expected that there will be 150-200 people attending.

There will also be a display of some of the blankets that the residents made, as well as photos from the “Blankets of Hope” project that The Marvin residents have been involved with. To date, over 1000 blankets have been shipped to wounded military personnel.

The success of The Marvin proves that dreams, visions and goals can become reality – with lots of hard work, commitment and steadfast drive. We are extremely proud to be celebrating The Marvin’s 11^th Anniversary as a unique intergenerational program, providing quality, affordable congregate elderly housing with supportive services and a school readiness child daycare program. We are always “Telling our Story!” 

 How can you plan a similar celebration for your community in just seven weeks? Take some tips from our AAHSA Homecoming Week toolkit and start planning your celebration today!

Questions and concerns  nursing home quality throughout Tennessee is making the news. But it isn’t all one sided.

Recently, The Tennessean published an editorial that AAHSA CEO Larry Minnix and the  Tennessee Association of Homes and Services for the Aging’s Exeuctive Director, Carrie Ermshar, wrote together about transforming the fears about nursing homes into hope. I think it’s a great example of why providers must address today’s crises and challenges head on  to ensure a better  for tomorrow.  Here’s what they had to say:

We must move from fear to hope on elderly care

By LARRY MINNIX
and CARRIE ERMSHAR

Recent events at McKendree Village have fueled double-edged fear about nursing homes. The public fears bad care. Nursing homes fear unfair inspections. Fear is a reckless driver.

Experts agree that nursing care needs transformation. “Quality” is inadequately defined and, too often, the caregivers who deliver it are inadequately supported. The inspection process is geared toward rigid compliance with myriad regulations, and enforcement is inconsistent. Reimbursement payment to providers is woefully low — roughly $6 an hour in Tennessee. (Try hiring a babysitter or finding a good hotel for that.) Policy changes are too often driven by ignorance, Band-Aid planning, self-interest and political expediency. The needs of residents and caregivers are often lost.

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So, how do we move from fear to hope?

Providers need to manage better. While all nursing homes face challenges, many achieve strong staff retention, good inspections and high consumer satisfaction.

We must embrace continuous quality improvement as a management practice. Providers must also acknowledge that staffing is the best proxy for quality and concentrate on human resource retention and development.

Policy-makers should use the National Commission for Quality Long-Term Care’s recent report as an honest appraisal and visionary guide to a new era of quality we can trust. Year-to-year planning on how to cut Medicaid or create more regulation does not work. Gov. Phil Bredesen served on the commission, which was led by Bob Kerrey and Newt Gingrich.

The commission believes long-term care should be based on consumer needs and choice; support of family caregivers; respect, livable compensation and contemporary training for staff; use of technology to maximize the independence of older consumers; make provision of care more efficient; and a financing system that ensures access to long-term care.

McKendree Village has a history of community respect, a status that they will earn again. But because of McKendree’s strong track record and the difficulties even they experienced, we must wonder if the whole system of nursing home care and regulation needs attention.

There should be two kinds of nursing homes: the excellent and the non-existent. It is time to transform fear into hope. All of us have a role to play in getting there.

Remember the New York Times story about private equity nursing homes? Well, members of Congress didn’t take it lightly. In fact, they held two hearings about the issue addressed in it last week.

At a Ways and Means Health Subcomittee hearing, scrutiny was the name of the game. Chairman Pete Stark (D-Calif.) even called for a Government Accountability Office report on nursing home ownership’s impact on the critical elements of quality: adequate staffing and transparency. And none of nursing-home-chain owners were there to argue against it.

Then came an analysis on the Senate side. That’s where the support comes in.  Don’t get me wrong, there was some scrutiny, but Committee members also talked about the work nursing homes were already doing to make their facilities more transparent and accountable to the public.

That work includes participating in the Advancing Excellence in America’s Nursing Homes., which hundreds of AAHSA members are doing now.  Sen.  Charles Grassley (R-Iowa) even said it was “vital” that more nursing homes participate in the campaign.

The Committee also hear from Denise Zabel. She’s an AAHSA member, and the  daughter of a nursing home resident, who spoke about her experiences on “both sides” of the situation.

Whether you scrutnize or support nursing homes, the real question is, will any of this analysis create solutions?

We had better know how to connect with consumers. Our scenario planning document, “The Long and Winding Road,” shows that consumer behavior is one of the two biggest uncertainties for the next decade. (The other is talent availability, which will be addressed in another letter.) What will consumers need? Want? Expect? Will the people be available to provide the services the market needs?

I’d like to comment on consumer connections in two dimensions: the science and the art of understanding and responding to basic human needs in our work. I’ll spend more time on the art because there is an abundance of resources on the science.

Of course, market studies are now an essential part of strategic planning and day-to-day management of current and future service. Regular, daily consumer feedback and response are rapidly becoming the norm, and the ability to analyze that information to generate effective and satisfying consumer service may be the most important management work we can do. There are numerous tools and business friends that can help with the most important driver of our work: understanding perceptions of the people we serve and those who serve them. The science of marketing is complex, but we must master it.

While the razzle-dazzle of marketing science is increasingly critical in our increasingly sophisticated work, I hope we can remember the fundamentals of the art because the fundamentals continue throughout our ongoing service relationship with the people who call on us to help them. This hit home to me recently through a colleague with a mother in crisis. Demented, frail, combative, falling apart, this elder went through a saga that began in an assisted living facility and continued through hospitals, nursing homes, a mental health unit, a rehab facility and a home health agency. My friend and her sister went with her. You know from your own experience that this typical family predicament is difficult in the best of conditions.

As my friend reflected on the situation, she said, “Maybe I’m expecting too much…” I picked up on that statement, perhaps thinking she and her sister were unrealistic—wanting cure where there could be none, wanting an idealistic relationship with their mother that will never exist again, wanting restoration to health where irreversible damage has taken its toll. So I asked her, “What did you expect?” She had no trouble in responding — these are mostly her words—so listen carefully—it is the market speaking through this daughter, who is YOUR colleague—and they apply regardless of the types of service you offer.

1. I expected my mother to be offered a good quality of life for the condition she was in. I expected that she not be avoided because she is unpleasant.
2. I expected her to be clean, well-fed, have interaction and receive the attention the facilities said she would be given and that we paid for.
3. I expected her to be treated with dignity even if she is beyond understanding her condition.
4. I expected staff to let me and my sister take the time to tell them what a wonderful person my mother used to be because all they see now is a crotchety, difficult demented woman.
5. I expected them to believe us when my sister and I said something was wrong.
6. I expected the long-term care facility to know my mother’s medical problems well enough to know that there was a developing crisis.
7. I expected the hospitals where she was transferred to diagnose and fix what they could—not discharge her with an infection she didn’t enter with.
8. I expected my mother to be released from the hospital when her medical problems were resolved, not when she ran out of coverage.
9. I expected professional guidance from professional staff, with a doctor who takes leadership responsibility for coordinating medical care and nurse leaders who would advise me and my sister on what we should do.
10. I expected nursing staff to recognize that cleaning my mother or giving her a treatment and putting her back into a soiled bed isn’t good. Simply saying another department didn’t do its job is not acceptable.
11. I expected on-site advocates—not 1-800 numbers.
12. I expected someone to empathize with me when I sobbed about my mother’s obvious state of affairs—not ask me what’s wrong.
13. I expected to be able to trust the people and institutions to provide good professional care and support my sister and me through all of this.

Too much to expect? Maybe all of our marketing, hospitality, sales and consumer relations programs should begin and end with asking people like my colleague and her sister what they expect throughout the service delivery process… Is that too much?

The great organizations stay closely connected to expectations and needs of the people we serve—connected most closely and intimately in the midst of crisis, not just through the perspective and distance of sophisticated science, though both are essential. No, that’s not too much to expect of us, is it?

Larry

William L. Minnix, Jr., D.Min.
AAHSA
President and CEO

John Picken, board chair of AAHSA member Kendal at Oberlin, and Benjamin Franklin think alike about not-for-profits.

Franklin established the Leather Apron Society in 1727 based on the premise that “The good that men do separately is small compared with what they do collectively.”

Thus, the birth of the American not-for-profit organization. Our own publication, The Not-for-Profit Responsibility — Changing Lives, Enlarging the Hearts of Communities, quotes Franklin’s belief that benevolence is the binding virtue of society. A century later, Alexis de Tocqueville commented that community action for the public good was honorable and uniquely American.

Fast forward a century. Peter Drucker discerned three fundamental sectors of American society that make it vibrant: business, government and not-for-profits. Each sector has a unique responsibility. Government’s is to protect and oversee. Business’ role is to generate an economy. Not-for-profits’ responsibility is to change lives. More recently, Dr. Lester Salamon, director of the Johns Hopkins Center for Civil Society Studies, defines four major duties of the not-for-profit sector:

• Guardians of values
• Service providers to meet emerging and often difficult societal needs
• Advocates for those often without public voice
• Creators of community (or social capital)

Salamon, in his must-read book for not-for-profit boards, The Resilient Sector, offers facts and figures on the size, scope and impact of this sector on the American economy and our way of life.

Even more recently, Dr. Claire Gaudiani of Yale University, in another must-read book for boards, The Greater Good, discusses how American generosity is the economic engine that drives capitalism as an essential dynamic of democracy. Dr. Gaudiani, who will be a keynote speaker at our 2007 Annual Meeting & Exposition in Orlando, says, “The ultimate form of generosity is the investment in people, property, and ideas.” She reflects on Maimonides, who wrote centuries earlier about the eight states of Tsedakah (which means “generosity that acknowledges the dignity of the receiver”):

“The highest level of Tsedakah is to enter into a partnership with the person in need so that he will become productive and eventually independent.”

Gaudiani has a chapter in her book on the fragile balance between democracy, capitalism and generosity, in which she writes, “Most people think Americans are generous because we are rich. The truth is we are rich because we are generous.”

I submit to you that the “fragile balance” that makes America great rests on the broad shoulders of not-for-profit governing bodies: yes, the volunteers who are generous with time, commitment, money and influence; people who see need and are not afraid to take risks and work hard to meet it.

Most AAHSA members have boards that are bedrock keepers of this fragile balance. Our largest 100 members have average life spans of three generations, compared to our counterparts in the investor-owned sector, which have only a third of that. I’m not making a value judgment with that comparison, but I mention the difference because the not-for-profit sector is expected to fulfill a unique and enduring role: to change lives, enlarge the hearts of communities, guard values, advocate and meet changing needs when it isn’t profitable to do so.

Therefore, governing bodies need to know their jobs. In these complex times, many of our boards are asking that very question: “What is our responsibility?” Public pressure from Congress and the media, spurred by high-profile scandal, raises another question, “How do not-for-profits stand accountable for the recognition American society affords us through tradition and law?”

Salamon concludes that the not-for-profit sector is in danger of “losing its soul” because we act too much like businesses. Jim Collins of Good to Great fame also wrote a monograph, Good to Great and the Social Sectors: Why Business Thinking is Not the Answer (another must-read for our boards), in which he details special characteristics of mission-driven versus profit-driven enterprises.

Which brings me back to John Picken, who put the issue to me like this (I’m paraphrasing): Can our members and their boards “cite the good they do?” Do they “know the difference between doing good and doing well?”

Our boards must answer Picken’s question! But how? There are numerous experts and tools to guide a thoughtful reflection process. Quality First offers an excellent framework for essential board talk. We have a social accountability guide we developed with the Catholic Health Association. We even published a resource that your organization can use to establish a social accountability program in 60 minutes. Experts like Richard Chait, William Ryan and Barbara Taylor are also helping members through their book Governance as Leadership and presentations at national and state meetings. Accreditation through CARF-CCAC is an excellent process that stimulates reflection about effective governance.

This year, AAHSA will hold town hall meetings all over the country about our not-for-profit responsibility and how we must stand accountable for our actions. You’ll find the questions we’ll be asking on our Web site. You can use them to hold a town hall meeting in your organization. I invite you to share your results with me.

The health of American society depends on such dialogue to maintain that essential yet fragile balance of democracy, capitalism and generosity. A key outcome of that dialogue is John Picken’s challenge to know the difference between doing good and doing well. Not-for-profits must do both, or we will not fulfill our unique responsibility.

LarryWilliam L. Minnix, Jr., D.Min.
AAHSA President and CEO

Find more governance resources from AAHSA.

Jan. 23, 2007

You need to know the AAHSA Plan for 2007-2008 and what you can do to advance it. The plan is based on the unprecedented confluence of the following information.

Scenario Planning Process — All AAHSA members are receiving by mail an outstanding publication about the future called the “Long and Winding Road,” our updated 10 year scenario planning report. It identifies “consumer behavior” and “talent and workforce availability” as the biggest uncertainties we face in the next decade. I ask you to read it, download supporting information from our Web site and make it a source of strategic discussions throughout your organization.

Member and Employee Satisfaction Surveys — The 2006 AAHSA Member Value Survey pointed out member diversification and overall satisfaction with AAHSA. More than 75 percent of our members are providing some kind of home-oriented services. Approximately 75 percent conduct a resident/client satisfaction survey, but only 25 percent conduct staff satisfaction surveys. I ask you to keep transforming your organization with an eye toward helping older people stay in a place they call home. And, conduct regular client and employee satisfaction surveys. Those who know most about the people they serve and work with will be tomorrow’s successful organizations.

Quality First — Quality First is our multi-year quality improvement plan to achieve excellence and earn the public trust. At its core are “Tell Your Story” and “Live Your Story.” It is based on a continuous quality improvement management and governance culture. It is for all members. Quality First has begun to change the national discussion from punishing nursing homes to transforming aging services for all Americans.

The National Commission for Quality Long-term Care published an excellent booklet called “Out of Isolation: A Vision for Long-term Care in America.” It is clear, simple and outlines the six major area of systems change that challenge America’s aging services continuum. It is a “must read” for your board and other constituents.

I ask you to advance Quality First and report your results. Our Web site is full of tools, examples and case studies that you can use to be successful.

If you are a nursing home, sign up for the new Nursing Home Quality Campaign, a supplement to Quality First. More than 1,200 nursing homes have signed on to measure new and existing quality measures. This voluntary campaign is an unprecedented collaboration on the part of providers, consumers, professionals and government. The campaign reinforces existing quality measures and it introduces process measures related to resident and employee satisfaction.

With these core priorities outlined, below is a summary of our 2007-2008 business goals to advance our mission of creating the future of aging services.

1. To Tell Our Story More Boldly
Our 2006 Annual Meeting & Exposition in San Francisco was a phenomenal experience of storytelling. We all need to get really good at it through annual reports, media relations, resident life history programs and policy maker visits to your organization. The popular media is still focused on negative stories of personal experiences. Our 2007 Annual Meeting in Orlando, Fla., will follow-up on that storytelling journey. The theme is “Live Your Story.” It will remind us again that storytelling changes lives, reinforces fundamental values and underscores enduring truths. It is up to us to change the perception of our work. Perception is reality until we change it.

2. To Strengthen Our Leadership Position
We must continue to position AAHSA members as transformational leaders. We need to be advocate leaders, thought leaders, innovation leaders and statesperson leaders. We will continue to convene leadership groups like CAST, our Long-term Care Financing Cabinet, our Affordable Housing Cabinet and our Faith-Based Cabinet as national models to be emulated locally. We will continue to offer tailored leadership development programs for you and your team. To paraphrase Jim Collins, greatness is a matter of conscious choice and leadership is the key. Leadership matters.

3. To Develop Innovative Models of Care and Services
Some of our members have organizational histories dating back to post Civil War. Yesterday, they were leaders of widows and orphans homes. Today, they are leaders in comprehensive gerontological centers, non-traditional housing models, geriatric rehabilitation, hospice and much more. These same organizations and newer ones like them will lead us into the future. We have led innovation for two centuries — where human need has arisen, our member ancestors have met it. It requires courage, hard work, vision and commitment. We all need to be innovators, and we all need to learn more from each other. I have not found a problem yet that one member faces that another hasn’t addressed successfully, nor have I seen a need that a great not-for-profit hasn’t figured out how to meet.

4. To Advance Advocacy Activism
We know all too well that if we don’t actively advocate for the right policies for the right reasons, bad things will happen through ill-conceived law, regulation or litigation. All of us — including residents, families, staff and boards — must tell our story to policy makers. They listen to somebody’s story every waking hour of every day. That’s how bridges to nowhere get funded and housing and Medicaid don’t. Activism. You must personally and organizationally get involved in advocacy. AAHSA makes it easy for each of you to “Contact Congress” through our Web site. You can express an opinion in less than a minute. You no doubt remember “minute men” from American history class. Today we need “minute people” to get Congress’ attention on key issues.

5. To Reinforce Membership Value
You value AAHSA membership. Thank you. Those who use our Group Purchasing program have collectively saved more than the amount AAHSA receives in dues from all members. Many of you who use our affinity insurance program have similar results. But more important, as one of our members leaders put it, “Every major innovative idea my organization has implemented has come by way of AAHSA.” Our member survey reflects that those who get involved feel more value. It’s called the Power of Community.

6. To Strengthen Relationships with State Associations
Gone are the days when there were clear lines between state and national issues — and between states themselves. We are all in this era of transformation together. While each state has its local dynamics, character, economy and demographics, one thing binds all of us: our aging parents and friends deserve consistent, secure and competent care and services through policies that make quality an automatic public expectation.

Therefore, AAHSA—which is you, our members—is a state and national team. “Think global, act local” and “standing alone together” are two guideposts I use to describe the great relationship we have with state partners. It is incumbent on members and professional staff to see that we synergize and energize our advocacy, shared and storytelling. Together.

7. To Advance a Culture of Discipline
Jim Collins’ Good to Great paradigm includes developing a Culture of Discipline. Like each of you, AAHSA needs to continuously improve our planning and management processes to help you do your job more effectively. Simply put, our job is to help you help the people you serve and those who care for them. To lead you requires that we be the best we can be based on your ever-changing needs. To help us continuously improve, we want your feedback and participation at state and national levels.

A new era is emerging. AAHSA has a responsibility to lead and serve through the Power of Community.

That’s the plan. Let us know how we’re doing — and how you’re doing.

LarryWilliam L. Minnix, Jr., D.Min.
AAHSA President and CEO

Oct. 5, 2006

Last Friday, we participated in an unprecedented quality summit. The purposes of the summit were to draw a baseline on where quality stands in nursing homes, model a new relationship paradigm with stakeholders — some with whom providers have had adversarial relationships — and to take an experimental step in the Quality First journey. The experiment is a campaign called “Advancing Excellence in America’s Nursing Homes” and its mission to improve quality of life for nursing home residents and staff. It is a focused, voluntary, two-year initiative. To clarify up front, this campaign does not replace Quality First. If successful, the campaign and the processes used to advance it will enhance Quality First.

So this is a report on where quality stands today and how we plan to move forward.

Context and History

Four years ago, we, the American Health Care Association (AHCA) and the Alliance for Quality Nursing Home Care publicly committed to Quality First, a national quality improvement plan to demonstrate excellence and earn public trust. While Quality First covers the total aging services continuum, it was widely recognized that the nursing home sector had been embattled for years and we found ourselves in a “crime and punishment” approach to public oversight. After pointed feedback from policy and consumer leaders, we reasoned that the only way out of this awful dilemma was to take responsibility for quality based on continuous quality improvement (CQI) principles. Quality First was born.

While our members have traditionally delivered quality, good works were overshadowed by isolated bad incidents and bad care or deceptive business practices by a few. Yet, it was evident that quality is achievable, measurable and worthy of public good will. And it is my experience there’s more good care available than we’ve been given credit for. Quality First would enable good providers to shine and the chronically incompetent and ill-motivated to be run out of business. Quality First was designed to build on other quality initiatives like Pioneer Network, Eden and Wellspring, and to complement the Centers for Medicare and Medicaid Services’ (CMS) Nursing Home Quality Initiative of 2001.

In the ensuing four years, we’ve had the opportunity to discuss Quality First with numerous groups — including the Founders of the new campaign. These interactions have led me to six major conclusions about quality:

1. Quality is getting better, though more must be done. Quality measures and process improvements are in their infancy for many of us.
2. Workforce is the key to quality and we must address caregiver needs.
3. We need to understand consumer perceptions and enlist consumer groups to help us fulfill Quality First.
4. We have more collective knowledge than we are effectively using.
5. Many key policy makers don’t really understand the complex issues we face and, therefore, are not making the most constructive policy decisions.
6. All interested parties: consumers, government, providers, professionals and business, must work together better if quality nursing home care is to become the automatic public expectation it should be.

A Definition of Quality

To pursue nursing home quality, we must define it. The Founders of the new campaign drafted the following definition:

We’ll see how well this definition wears over time.

Where Quality Stands

Here are the summary bottom lines from various sources, much of which was expressed at the quality summit.

1. Improvement in nursing homes is evident in several CMS quality measures. Use of restraints and pain management are two examples. No progress is evident in pressure ulcers for a variety of reasons. Refinement of measures will be an ongoing concern.
2. Culture change initiatives are proving successful in improving staff retention, with correlations to quality and cost-effectiveness. While studies are relatively small in scale, it is abundantly clear that respect and effective human resource management can make a major dent in the 70 percent average turnover rate nationally for certified nursing assistants (CNAs). One study reports a rate of 10 percent staff turnover based on culture change. We know that staff turnover rates will never be zero and shouldn’t be because a certain amount of turnover is healthy. But a national average of 70 percent is too high, and culture change helps bring that number down.
3. No one really knows in a collective and disciplined way, how residents and families evaluate the services we offer. Our recent AAHSA Member Value Survey found that two-thirds of our members perform resident satisfaction surveys, but little is known about how those results get reported and used to improve quality. There is no national profile for resident satisfaction. Approximately one-third of our members conduct employee satisfaction surveys, but again, little is known about what changes these surveys generate.
4. The momentum behind Quality First is growing. Two-thirds of AAHSA members have signed the Quality First Covenant. In AAHSA’s recent member survey, approximately half of our members report they are using Quality First to help them improve. Interestingly, approximately one-fourth of those who have not signed the covenant say they, nevertheless, are using Quality First to improve. We have strong anecdotal information about how Quality First is helping to transform organizations. Our Web site is full of Quality First member success stories.
5. National leaders who spoke at last week’s summit are recognizing that quality care is a national responsibility, and that the financing of it needs to be revamped. While no one promised more money, there is general acknowledgment that quality should be defined and paid for adequately, with financial incentives for good care. Emerging themes at the meeting were changes that allow people to stay at home longer, redirection of dollars to follow clients and the potential for technology to improve care and cost.
6. Sen. Charles Grassley (R-Iowa) addressed the summit. He is a skeptic about voluntary self-responsibility initiatives, and stressed his support for strong survey and certification oversight. He reported that there are several hundred chronically bad providers who should be shut down but are not. Sen. Grassley, and those groups who reinforce his view, are our acid test critics. While we disagree with his conclusions about the effectiveness of voluntary initiatives, we have much work to do to prove him wrong. And we agree that the bad apples should be discarded. The issue becomes how to support CMS and the state agencies in accomplishing that objective.

What Should We Do Next?

1. Full steam ahead with Quality First! I believe we are close to the tipping point in its effectiveness. The Quality First Elements need to be embedded in every member’s culture. There is plenty of evidence that this is occurring. Quality First is taking root.
2. Implement consumer and staff satisfaction surveys, use the results for improvement and report findings through annual reports and newsletters.
3. Embrace culture transformation. It is our salvation.
4. If you are a nursing home, sign up for the “Advancing Excellence” campaign. This is a way to show that voluntary efforts can be successful. Your participation will give us reliable, collective national data on improvement.
5. Learn to tell our story better locally and nationally.

At the close of the “Advacing Excellence” summit, I asked one of the dozen or so nursing home residents in attendance how he would “bottom line” the day. He replied, “It looks like if residents and staff are given the respect they deserve, and the people that run these places will train people well and have better communication, we shouldn’t have too many problems.”

Yes, let’s ask the consumer what he or she thinks. It could be enlightening and helpful on this next phase of the Quality First journey. And let’s see what this campaign can teach us about quality improvement, working more collaboratively with other groups and the effects we can have on policy makers. We have a big opportunity and responsibility to lead permanent transformational change. Yes, we are close to a tipping point!

Larry

William L. Minnix, Jr., D.Min.
President and CEO

Write your representatives

AAHSA
2519 Connecticut Ave NW
Washington DC 20008

Aug. 1, 2006 

Last Friday, the Centers for Medicare and Medicaid Services (CMS) announced in the Federal Register that it is participating in a two-year campaign called “Advancing Excellence in America’s Nursing Homes.” The campaign was founded and will be implemented by an unprecedented coalition of consumers, providers, foundations, government agencies and other professional leaders. I am privileged to be the initial chair of the steering committee of the groups involved to see that this campaign is successfully implemented.
As stated in the Federal Register notice, “the ultimate objective of this new nursing home quality campaign is to make a real difference in the quality of life and efficiency of care delivery in nursing homes, by accelerating progress in identifying and treating pain and pressure ulcers, by virtually eliminating the use of physical restraints, and by transforming the nursing home work environment to attract and retain nursing and other staff.”

But this campaign is so much more than that. The “Advancing Excellence” campaign is designed to make a great leap in Quality and Trust and is a major enhancement to Quality First for nursing homes. For the first time, numerous ongoing quality initiatives including Quality First and the CMS Nursing Home Quality Initiative (NHQI) are coming together and incorporating the culture change activities of organizations including the Pioneer Network, Eden Alternative and The Wellspring Institute.

The campaign is significant in ways that may not initially be apparent. First, the coalition brings to the table many groups, some of which traditionally have not worked together. Key stakeholders involved in the planning of the “Advancing Excellence in America’s Nursing Homes” campaign include: Alliance for Quality Nursing Home Care; American Association of Homes and Services for the Aging (AAHSA); American Association of Nurse Assessment Coordinators (AANAC); American College of Health Care Administrators (ACHCA); American Health Care Association (AHCA); American Medical Directors Association (AMDA); Centers for Medicare & Medicaid Services (CMS) and its contractors, the Quality Improvement Organizations (QIOs); The Commonwealth Fund; The Evangelical Lutheran Good Samaritan Society; National Association of Health Care Assistants (NAHCA); National Citizens’ Coalition for Nursing Home Reform (NCCNHR) and the National Commission for Quality Long-Term Care.

Second, consistent with Quality First, this campaign gives nursing homes the opportunity to commit openly to specific quality measures so that we can all “stand for” quality and not be defensive about it. The goals that the coalition has identified seek to improve clinical care; incorporate nursing home resident and family satisfaction surveys into continuing quality improvements; and increase staff retention to allow for better, more consistent care for nursing home residents. Nursing homes can volunteer to be measured on these indicators, showing the public we are confident about our commitment to quality.

Third, for the first time, a quality improvement initiative includes in its process measures indicators related to consumer and staff satisfaction. This allows these most important voices of consumers and staff members to speak for themselves. Every serious study of long-term care improvement – including our studies around Wellspring, Pioneer and Better Jobs Better Care point to the health of our workforce as the single biggest key to quality improvement. Caregivers will finally receive the attention they deserve.

Lastly, the campaign will have important synergy with the National Commission for Quality Long-Term Care, the so-called “Quality First Commission.” Chaired by former Sen. Bob Kerrey and former Speaker of the House Newt Gingrich, the commission is one of the founders of this new quality campaign. The Commission is another platform to focus the quality campaign’s results on solutions for our field and for our policies. As it enters a new phase, the Commission will also focus our country’s attention on how long-term care should be financed. It is difficult to talk about quality without addressing the underlying question of how we will pay for the quality we expect and deserve.

Through this campaign, we have a new visible way to tell the story of the quality you’ve provided for decades and our shared commitment to the transformation of our field. For those of you who do not offer nursing care, the campaign’s focus on customer and employee satisfaction can help you focus your own quality first efforts, consistent with Quality First’s 10 Elements of Quality. Some of our most innovative applications of Quality First have come from our housing and home and community-based services members. That’s why I urge you to sign the AAHSA Quality First Covenant and to develop a plan that focuses on these areas of your work.

This campaign will launch at a Quality Summit on Sept. 29 in Washington, D.C. We expect about 400 people to attend to assess quality in today’s nursing homes; the need for public confidence in long-term care; the role of the caregiver workforce in quality improvement and how the campaign will be implemented at the national and local levels. Invited participants include leaders from the consumer, provider, government and philanthropic sectors. Shortly after that, nursing homes will be asked to volunteer to participate.

This campaign is an opportunity for nursing homes to earn their rightful trust in the public’s eye as a care sector that is known for excellence and worthy of the public’s trust. Our mantra is that quality should be an automatic public expectation. We — and you — are helping to fulfill that promise.

Larry

William L. Minnix, Jr., D.Min.
President and CEO