Office of Facilities Regulation

Individualized Care Pilot for Nursing Homes

The State Survey Agency for Rhode Island, a program in the Rhode Island Department of Health’s Office of Facilities Regulation, conducted an Individualized Care Pilot (ICP) as part of the standard federal and state recertification survey at 51 Rhode Island nursing homes between November 1, 2007 and April 30, 2008.  Planning for the project commenced in December 2006 and final products were completed in December 2008.  This website presents the tools and educational products developed by the project, as well as resulting recommendations and dilemmas.   This information is of potential interest to nursing home providers, State Survey Agencies, federal regulators, culture change coalitions, nursing home residents and their families, long-term care researchers, and public policy makers.

The Individualized Care Pilot project was developed with support from the Centers for Medicare and Medicaid Services (CMS) and with funding in part from The Commonwealth Fund.   HEALTH’s educational partner for the project was Quality Partners of Rhode Island.    The purpose of the project was to “use the mandated regulatory process to motivate and enable all nursing homes to fully realize the potential for resident-centered care inherent in the Nursing Home Reform Law…(OBRA’87).”   It sought to promote individualized, resident-centered quality of care and quality of life for nursing home residents by:

• Disseminating understanding and awareness among nursing home providers, survey agency staff, nursing home residents, and other stakeholders about how federal and state regulations support and mandate implementation of individualized, resident-centered care in order to achieve the highest practicable physical, mental, and psycho-social well-being for each nursing home resident;
• Supporting implementation of practices that meet regulatory requirements and accomplish individualized resident-centered care in three key areas: Resident-Directed Choice; Staff-Resident Relationships;
  Personalized Environment.

Results from the project include Recommendations, Lessons Learned, and Regulatory Dilemmas, as well as multiple final products that can be utilized or adopted by others.  Final products are:

• the Individualized Care Pilot TOOLBOX, a report in five modules
  Executive Summary
  Module 1– Individualized Care Pilot - Recommendations and Dilemmas
  Module 1 – Appendices
  Resident Educational Brochure - Group Interview Handout
  Individualized Care Investigative Protocol
  Individualized Care - Tour Observations
  Administrator-DNS Questionnaire
  Medical Director Questionnaire
  
  Module 2 – Individualized Care Pilot -Design Process
  Module 2 – Appendices
  ICP Pre and Post Surveyor Questions
  Is the Regulatory Process a Barrier to Providing Resident-Centered Care? – Barriers Survey by Dr. David Stevenson
  Technical Expert Panel Members
  Individualized Care Investigative Protocol
  National Advisory Panel Members
  
  Module 3 – Individualized Care Pilot  - Surveyor Training
  Module 3 – Appendices
  ICP Pre and Post Surveyor Questions
  Individualized Care Investigative Protocol
  
  Module 4 – Individualized Care Pilot - Survey Tools
  Module 4 – Appendices
  ICP Version 3 - Documents & Forms
  ICP Version 4 - Documents & Forms
  
  Module 5 – Individualized Care Pilot - Information and Education for Providers
  Module 5 - Appendices
  Is the Regulatory Process a Barrier to Providing Resident-Centered Care? – Barriers Survey by Dr. David Stevenson 
  Information and Resources:  Implementing Individualized Care for Nursing Homes
  (Change Packets)
  Individualized Care Organizational Self-Assessment Tool (ICOSA)
  ICP Survey Entrance Conference Letters
  from RI Department of Health and Quality Partners of Rhode Island
  Announcement to Nursing Home Providers About Start of Pilot
  Press Release Announcing Individualized Care Pilot
  October 29, 2007
  Idea Exchange – Explanation and Submission Forms
  Non-Regulatory Feedback Report to Providers with Cover Letter

• a  video of Rhode Island long term care surveyors reflecting on their experience of implementing the pilot:
• educational materials for providers that describe how to implement individualized, resident-centered care practices;
• an article about the innovative SSA-QIO partnership between the Rhode Island State Survey Agency and its quality improvement organization Quality Partners of Rhode Island;
• a Surveyor Training Manual for State Survey Agencies:
• the Individualized Care Investigative Protocol for long term care surveyors;
• an educational brochure for residents and their families, distributed during the survey’s group interview;
• and a summary of aggregated data collected during the 51 pilot surveys.

The project is grateful to the Technical Expert Panel members who provided advice during the design of the pilot and to the National Advisory Panel members who provided feedback during the implementation phase and formulation of the Individualized Care Pilot TOOLBOX.  View a list of national expert panel members and project staff.

An independent evaluation of the project will be available from Dr. David Stevenson at Harvard Medical School Department of Health Care Policy at Stevenson@hcp.med.harvard.edu

For questions about the Individualized Care Pilot, call Marie Stoeckel at 401-222-4520 or email her at Marie.Stoeckel@health.ri.gov.