Partnership aims to improve quality, consistency in Wisconsin assisted living communities

// Industrial & Systems Engineering

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photo of CHSRA researchers
From left to right, Kevin Coughlin (DHS), David Zimmerman (CHSRA), Edmond Ramly (CHSRA), Susan Nordman-Oliveira (CHSRA), and Jay Ford (CHSRA).

Assisted living communities exist in many forms—including adult family homes, which care for four to eight residents with special needs; community-based residential facilities; and residential care apartment complexes—and provide valuable housing and care options for people who can’t live in their own homes but do not need and aren’t qualified for skilled nursing facility (SNF) care.

Yet, for states around the country, assisted living communities have proved to be a regulatory challenge, especially since there is no federal authority for such regulation. Because they are so diverse and so ubiquitous (there are more than 3,000 in Wisconsin alone), states find it difficult to provide any sort of firm regulation or even quality improvement guidance.

Now, a new partnership among the Center for Health Systems Research and Analysis (CHSRA) at the University of Wisconsin-Madison, the Wisconsin Department of Health Services, and assisted living communities across Wisconsin aims to improve the quality of assisted living communities by developing a quality improvement process that is based on existing quality improvement initiatives by assisted living associations and that also can be linked to the regulatory process. This collaboration, the Wisconsin Coalition for Collaborative Excellence in Assisted Living, or WCCEAL, recently received a Wisconsin Partnership Program community impact grant, which will allow these groups to further develop and expand a system that has been in the works since 2009.

David Zimmerman, a professor emeritus of industrial and systems engineering at UW-Madison and a senior scientist at CHSRA, says standards are a much-needed commodity for operators of assisted living facilities. “When the industry decided to peel off the group of residents who needed less skilled care, and put them in a different place, the money followed but the quality assurance never did,” Zimmerman says.

The researchers are collecting data from varying facilities and establishing benchmarks for improvement. In this way, they connect all of the stakeholders, including residents, communities, provider associations, and state agencies that fund these communities.

The project unites the principles of systems engineering, human ergonomics and healthcare. All four assisted living associations in Wisconsin are working with researchers in the coalition, and as of December 2015, a quarter of the people in Wisconsin who live in an assisted living community live in one that has joined the coalition.

One of the coalition’s major contributions is an annual survey that yields detailed resident feedback on areas such as dining and staff services, and through this data, the researchers have been able to help communities, evaluate them relative to their peers, and identify specific areas in which they can improve. For people who work in assisted living communities, this has provided a much-needed and rewarding method for evaluating the services they provide.

Susan Nordman-Oliveira, a researcher with CHSRA, cites one conference in which an assisted living community staff member lauded the comparative performance system the researchers have developed. “One of the providers was encouraging the rest of the audience to join the coalition, and said, ‘I always feel like I’m doing a bad job because I don’t have anything to gauge it on. Now that I am putting in some of my data and seeing whether I fall above or below the level of other provides. I feel like I’m being rewarded, like I’m doing something right. I’m not at the bottom, and I’m going to continue trying to move up,’” Nordman-Oliveira says.

Directors of assisted living communities also file quarterly reports that provide a summary of quality improvement initiatives and several outcome measures, such as fall prevention, infections, and rehospitalizations, as well as staff turnover; the reports also yield information that helps them set and maintain high standards.

The coalition earned a Bright Idea Award in 2015 from the Harvard Innovations in American Government program. In the future, organizers aim to expand their outreach to more assisted living communities as well as underserved communities and resident groups. By working under a common goal of quality improvement, the coalition has and will continue to harness the tools necessary to make lasting changes in the field. “If there wasn’t passion in this, the project wouldn’t have lived,” says Nordman-Oliveira. “A lot of people care. People have given extra time to this project because they know it’s important. Yes, we’re a research center and the nuts and bolts and the data are important to us, but we also care.”

Author: Lexy Brodt