State “Technical Assistance Programs” for Nursing Home Quality Improvement: Variations and Potential Implications

Abstract

To improve nursing home quality, many states have developed “technical assistance programs” that provide on-site consultation and training for nursing facility staff. We conducted a national survey on these state programs to collect data on program design, operations, financing, and perceived effectiveness. As of 2010, 17 states had developed such programs. Compared to existing state nursing home quality regulations, these programs represent a collaborative, rather than enforcement-oriented, approach to quality. However, existing programs vary substantially in key structural features such as staffing patterns, funding levels, and relationship with state survey and certification agencies. Perceived effectiveness by program officials on quality was high, although few states have performed formal evaluations. Perceived barriers to program effectiveness included lack of appropriate staff and funding, among others. In conclusion, state technical assistance programs for nursing homes vary in program design and perceived effectiveness. Future comparative evaluations are needed to inform evidence-based quality initiatives.

Keywords:

• long-term care
• nursing home
• quality improvement
• state regulations
• technical assistance program

Acknowledgments

This study was funded by the National Institute on Aging under grant R01AG032264. We thank Rosanna Bertrand, Terry Moore, and others of the survey team in Abt Associates, Inc., for collecting the data.

Notes

1. The only “mandatory” program in Texas does not require all nursing homes in the state to receive on-site technical assistance. Rather, it requires that only a subset of facilities identified as having problematic care receive unannounced visits and on-site consultations. However, none of these nursing homes are required to take the actions recommended by program officers during on-site consultations. Therefore, strictly speaking, the Texas TAP is still a voluntary program that differs essentially from the mandated quality inspections during annual survey and certification process. The implications of the unique design of the Texas TAP (versus other completely voluntary programs) are left to future research.