A study released by The Commonwealth Fund in December examines the impact of a regulatory initiative developed by the Rhode Island Department of Health (RIDH) to promote resident-centered care in the state’s nursing homes.
For the pilot project, the RIDH used the annual nursing home recertification process to raise awareness of how current regulations support resident-centered care and facilitate its implementation in nursing homes.
The “Individualized Care Pilot,” which took place from November 2007 through April 2008, was comprised of:
- an enhanced survey process;
- a visit to the nursing homes by the state’s Quality Improvement Organization (QIO);
- peer-to-peer sharing at monthly sessions hosted by the state survey agency and QIO; and
- educational activities, such as a resource binder and website.
Measuring Resident-Centered Care
The project was designed to promote three components of resident-centered care:
- resident choice in waking, sleeping, and bathing;
- personalized environment, specifically regarding sound levels, room decor, access to public/common areas, home-like bathrooms, and dining alternatives; and
- staff-resident relationships to support quality of care and quality of life.
The researchers conducted pre- and post-tests with Rhode Island nursing home administrators on several elements of resident-centered care and found that the initiative helped nursing home administrators to understand, consider, and implement resident-centered care.
Project Findings
More than 80 percent of the nursing home administrators surveyed reported that the pilot project had “either helped the facility begin to think about ways to make care more resident-centered or helped them to implement these changes.”
Among the study’s findings were two significant advances in resident-centered care:
- enabling residents to determine their own daily schedules
- implementing consistent assignment for certified nursing assistants
The researchers conclude that the “findings paint a promising picture about the potential to spur provider change through a multipronged approach centered on the regulatory process.”
“Rhode Island has demonstrated the increased potential for positive outcomes when regulators, providers, Quality Improvement Organizations, and other key stakeholders collaborate on behalf of person-centered care,” said PHI Director of Training and Organizational Development Susan Misiorski. “I hope other states will follow this excellent example.”
The study’s findings have been published in “The Impact of a Regulatory Intervention on Resident-Centered Nursing Home Care: Rhode Island’s Individualized Care Pilot,” a Commonwealth Fund issue brief by David G. Stevenson, Ph.D., Harvard Medical School, and David R. Gifford, Ph.D., M.P.H., director, Rhode Island Department of Health.
The “Individualized Care Pilot” was developed with input from the Centers for Medicare and Medicaid Services with funding from The Commonwealth Fund.
For information on PHI’s training and consulting services for nursing homes seeking assistance in implementing resident-centered practices, visit the PHI Training & Organizational Development Services website.
– by Deane Beebe
