Dec. 11, 2007

Last week was a milestone week for quality. The National Commission for Quality Long-term Care released its final report, From Isolation to Integration: Recommendations to Improve Quality Long-term Care. It is a must-read for AAHSA member boards, leaders, staff, residents and friends in each of our local communities. It is a thorough, deep, thoughtful, honest and visionary document - reflecting the quality of the citizens who developed it.

Chaired by former Senator Bob Kerrey and former house Speaker Newt Gingrich, the National Commission is composed of 21 leaders with wisdom and perspective in human services, including governors, senators and members of Congress. The commission has worked on its analysis and recommendation for more than three years.

My distillation of the commission’s major insights is as follows:

• Long-term care needs total transformation around the needs of the elderly and disabled, caregivers and the people who work in this great field.
• Transforming health care cannot be accomplished without transforming long-term care.
• Transformation of the scope envisioned will require presidential leadership.
• A transformational vision for the future must integrate quality, workforce, technology and financing. Continued fragmentation of all these efforts has produced a broken system.
• There is a demographic, financial and moral crisis at hand that calls for public outcry and political response.

The report’s transformational themes are reflected in its five fundamental criteria for reform. - Reform must ensure that long-term care:

1. Places the needs and preferences of consumers at the heart of every care setting and fosters the right of those consumers to make care and lifestyle decisions for themselves.
2. Provides adequate supports for family caregivers, without whom the nation could not care adequately for its aging citizens and citizens with disabilities.
3. Ensures that long-term care workers receive the training, compensation and respect they need to provide compassionate, high-quality care.
4. Adopts emerging technologies that will help maximize the independence of older consumers and make care provision more efficient.
5. Institutes a financing system that utilizes public and private resources to ensure that every American who needs quality long-term care will have access to those services.

The report makes more specific recommendations in the areas of quality, workforce, technology and finance to fulfill those five criteria. It is now incumbent on all of us and numerous stakeholders to evaluate this watershed report and develop local, state and national action plans. I will recommend to AAHSA’s Board of Directors that it be the centerpiece of AAHSA’s policy agenda for the next five years. We will initiate a process with AAHSA’s Board, House of Delegates and state leadership at our first board meeting this January in New Orleans. In many ways, AAHSA is already advancing the theme of the report, and I am proud to say AAHSA’s research activities are laced throughout it.

How did we get to a watershed movement about quality? Through Quality First! Launched five years ago by the three major provider associations, Quality First is a national quality improvement plan designed to advance excellence and earn the public’s trust. Initiatives like this are not new. Rather, they have been used in numerous sectors that needed to take responsibility for themselves in light of poor quality and public mistrust in our country over the last few decades.

The management science surrounding transformation, through quality improvement paradigm change, reflects that such change is a 5- to 10- year endeavor. It begins with a small group of innovators and early adopters, followed by majority involvement, with a minority who lag behind. Such national plans begin with a commitment to strive for quality, followed by detailed guidelines for member implementation and national reporting. Typically plans are overseen nationally by an independent, prestigious body of experts who recommend ways to improve performance in the sector. Thus, the National Quality Commission.

Quality First was also built on the initial development of the Centers for Medicare and Medicaid Services’ (CMS) Quality Initiative launched by U.S. Department of Health and Human Services Secretary Tommy Thompson in 2001. The headwaters of Quality First for AAHSA members, however, have deeper origins in programs like the Pioneer Network, Wellspring, Eden Alternative and social accountability. Quality improvement and the advocacy for it are traditionally part of the fabric of our members, many of whom have histories spanning generations.

How effective is the Quality First initiative?
First, approximately 70 percent of our members have committed to it. Most of those say they are using it to guide strategic planning and organizational improvement. Many members who have NOT signed the Quality First Covenant say they use it to improve.

Second, the National Commission has produced an excellent report with recommendations.

The principles of Quality First on the health care side have given birth to the nursing home program called Advancing Excellence (AE), which now has more than 6,000 homes committed. Early data not as yet released will reflect that quality on the key clinical measures is improving and that there are indications that those who participate in the AE campaign are doing better than those who are not.

Third, since we have gone on offense about Quality First, there has been no new, punitive national legislation to impose further regulation on nursing homes and assisted living.

Fourth, AAHSA has an excellent case study database of member examples of Quality First implementation. Other members use it to help their own journey.

What are we learning and what should we do?

1. Continuous Quality Improvement (CQI) Works! All of us need to embrace it and create a CQI management culture and way of life.
2. Transformation Requires Top Leadership Commitment Whether top leadership of our nation or top leadership among our members, quality improvement cannot be delegated. It is a top leadership responsibility.
3. Attention to Caregivers and Employees is Essential The neglected partners in long-term care are the individuals who provide the day to day support. Our Better Jobs Better Care work validates in detail the attention we need to give caregivers through support, empowerment, training, livable compensation and respectful supervision.


4. Know What Your Residents, Families and Employees Think If all of us were to implement a resident, family and employee satisfaction mechanism, we would have immediate feedback on where to improve.
5. Advocate for Transformation! Tinkering around the edges won’t solve our problems anymore. So, study the commission’s report, review the Quality First components and join me in developing the next phase of the Quality First agenda.

If my magic wand were working today, I would wave it and command immediate attention to our talent shortage. I’d transform how our field approaches human resources. I’d fix public policy and reimbursement to put our money where our mouth is. I’d reinforce once and for all that the relationship between those we serve and those who serve them directly is the nexus of quality. The rest evolves from there.

Advancing excellence and earning public trust are possible with continued, focused efforts towards consumer and caregiver-centered quality. Your results are showing that we are transforming the paradigm from what a spokesperson for the National Quality Commission says is "away from a punitive, regulatory approach to one of quality improvement for residents and those who care for them."

Big transformation! It is our responsibility!

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

P.S. Be sure to watch for the September/October issue of AAHSA's FutureAge magazine, where you'll find articles that profile members who take ethics and quality to heart, examine the characteristics of a just society, look at what determines an ethical corporate culture and more.

AAHSA · 2519 Connecticut Ave. NW · Washington DC 20008 · www.AAHSA.org