Quality

This is the first in a series of papers synthesizing the ideas and practices of states as they improve the quality of home and community based services (HCBS) and supports for older persons and persons with disabilities. Building on the experiences and challenges of the QA/QI Systems Change grantees, the paper addresses four fundamental questions about quality management. The intent is to provide an account of current practice, and a structure for how states view their options.

Washington developed this protocol for use when the recommended plan of care can not assure the health and welfare of recipients due to participant issues, environment, or resources. Addresses shared responsibility for participant safety. Addresses service denial and service termination. The purpose is to promote statewide consistency in dealing with difficult to serve clients before denying or terminating services.

Washington has developed protocols in some high risk areas, such as skin breakdown. Protocols are automatically triggered when certain characteristics are identified in the assessment (a pressure sore or history of pressure sore, incontinence with cognitive impairment, etc.). The protocols dictates referral and recommendations for caregiver follow up.

Washington’s automated, comprehensive, person centered assessment and planning tool measures the personal care needs of anyone receiving services at home or in a residential setting and develops a care plan. The tool contains 60 different screens, some relate to risk. Participant selects a service setting and then the program computes eligibility, need and a service plan that crosses settings. The package contains: CARES Training Manual, CARES Assessment, Eligibility & Rates for LTC Services.

Developed by Oregon’s Office of Home & Community these tools include consideration of 43 areas of risk and illustrates the state’s risk tracking documentation in Q&A format. They also provide instruction to staff with loops back to participant preference and guidance to protocols to address identified risks. Forms included: ISP Addendum, Financial & Individual Support Plan, Personal Focus Worksheet, Risk Training, Protocol for Aspiration, Constipation, Dehydration, Seizure and Signature Sheet.

Developed by the New York Department of Health this tool is used for participants with traumatic brain injury. The tool identifies risk factors and the services needed to mitigate them, and assigns specific persons who will be responsible for providing the necessary service and oversight. Addressed in the plan: money management, medication management, kitchen safety, back-up staffing for unscheduled staff absences. Plans are revised at least every six months and must be signed.

The National Core Indicators website is a collaboration among participating NASDDDS member state agencies and HSRI, with the goal of developing a systematic approach to performance and outcome measurement. The website offers information on the phases of the project, progress, summary and final reports, presentations and other tools. The site also extends the invitation to other states to join in the multi-state collaborative effort to improve performance.

This quality tool product was developed by the state of Arizona, Department of Economic Security. The Prevention and Risk Assessment form identifies risk in a variety of dimensions, including home, work, and the community. The tool identifies risk prevention and mitigation strategies, as well as needed supports and the individuals who can/will provide these supports.

This report compiles both written and verbal evaluations of twenty New Hampshire legislators who attended the Supporting Older Adults and Individuals with Disabilities in Your Community: An Educational Series for Legislators. The series was developed as part of the Real Choice Systems Change initiative in New Hampshire. The purpose of this evaluation was to review what aspects of the Educational Series were beneficial and to recommend improvements for future sessions.

In March ’01 the Department of Mental Retardation (DMR) began a strategic management planning process to develop a quality management and improvement system. The 2002-03 report derives information from a variety of quality assurance systems and databases. It is intended as starting point in the collective review & analysis of service quality. The data provided should be viewed as an opportunity to point out areas where the program is doing well as well as areas where improvements are needed.