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9 new quality goals for nursing homes unveiled by initiative

August 23, 2013
by Lois A. Bowers, Senior Editor
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In an effort to encourage nursing homes to collect and share data that may lead to uniform national standards and evidenced-based best practices, the Advancing Excellence in America’s Nursing Homes Campaign has released nine new quality goals and free toolkits to help facilities reach them.

“This effort demonstrates the campaign’s ongoing commitment to make nursing homes better places to live, work and visit,” says David Gifford, MD, MPH, senior vice president of quality and regulatory affairs for American Health Care Association and co-chair of the Advancing Excellence campaign.

The campaign, begun in 2006, is a coalition of long-term care providers, caregivers, medical and quality improvement experts, government agencies and consumers. Members aspire to establish standards and practices in line with the impending Centers for Medicare & Medicaid Services (CMS) Quality Assurance Performance Improvement, or QAPI, requirements and other government efforts.

More than 60 percent of the nation’s nursing homes (about 9,500) have joined the campaign, according to Cheryl Phillips, MD, senior vice president of advocacy for LeadingAge and co-chair of the Advancing Excellence campaign. Additionally, about 3,000 nursing home staff members and 3,600 consumers have signed on, she said in a conference call with members of the media.

The Advancing Excellence campaign is supported by 52 “local area networks of excellence” (LANEs). These state-level coalitions, the structure of which differs from state to state, are responsible for promoting the effort and engaging nursing homes in performance improvement. The LANEs disseminate campaign information and resources and organize statewide projects to improve nursing home performance related to campaign goals.


Gifford described the nine new quality goals — four process-related goals and five clinical goals — in the conference call. Facilities participating in the campaign commit to working on at least one process goal and one clinical goal.

Process goals:

  • Improving staff stability. “We believe that addressing staff stability is a cornerstone to all the other work,” he said. “If you’re having high turnover, it’s hard to implement any sort of … clinical guideline.”
  • Increasing use of consistent assignment. “The effort is to have the same staff taking care of the same individual each time they work,” Gifford said. “When you do that, the people know the residents, they know their likes, their dislikes. They know early, subtle changes when someone is getting ill. They know their routines. When you do the consistent assignment, you’re able to better achieve … person-centered care planning and decision-making.”
  • Increasing person-centered care-planning and decision-making. “It’s really hard to figure out, if you don’t know the resident[s] you’re caring for, what time they like to wake up, whether they like to bathe or shower, what music they like to listen to, what type of foods they like, whether they like to snack or not, whether they like coffee or tea,” Gifford said. “And when you have a consistent assignment, you can actually do much better person-centered planning and decision-making and really tailor the care level to the individual needs, which is what we all want for our family members and ourselves should we ever need to be in a nursing home.”
  • Safely reducing hospitalizations. “It turns out that a lot of these issues about consistent assignment, staff stability, communicating between the nurses and physicians, early detection of ... subtle changes in individuals, understanding people’s likes and dislikes, particularly around end-of-life counseling — all of those are critical information for figuring out how to reduce hospitalizations,” Gifford said.

Clinical goals: