Dehydration and unplanned weight loss because of inadequate food intake are common conditions among nursing home residents and can lead to costly adverse clinical outcomes. John Schnelle, Ph.D., studied the staff resources necessary to meet the dietary needs of residents and developed a package of materials, including risk assessment tools, feeding assistance protocols, and staffing models, to help nursing homes maximize available staff. Interest in the program is such that The Jewish Home for the Aging of Greater Los Angeles has established a prototype unit on two floors, where staff from other nursing homes can observe the model in action. Plans for further dissemination of the package are being developed.

The new CMS Nursing Home Quality Improvement Initiative mandates public reporting of performance measures and requires that Quality Improvement Organizations (QIOs) work with facilities in their respective states to improve quality. A kickoff meeting for the new initiative was held in Baltimore during the summer of 2002. To ensure consumer representation, the Fund provided a grant that enabled the American Health Quality Association to offer reduced conference fees and travel expenses for state ombudsmen and resident advocates. Mary Ann Kehoe presented the Wellspring model at the meeting, and a number of QIOs have since discussed using Wellspring training modules in their work. In addition, CMS is planning another evaluation of Wellspring, this time to include all 50 homes in the five active Wellspring alliances.

Because long-term care is a "high-touch" rather than a high-tech field, there is a direct link between the number and quality of staff members and the quality of care. A congressional briefing held in December 2002 discussed the critical shortage of front-line workers from the perspectives of consumers, providers, and organized labor. Mary Ann Kehoe presented Wellspring's strategy for staff retention through worker empowerment.

For the most part, the Quality of Care for Frail Elders Program has focused its work on not-for-profit nursing homes. To make an impact on quality improvement throughout the industry, however, the Fund has also engaged the for-profit sector, which accounts for roughly two-thirds of all American nursing homes.

Beverly Enterprises, the largest for-profit chain of nursing homes in the United States, has begun a "culture change" initiative to implement resident-centered care in nine facilities; if successful, the model will be adopted in additional homes. Leslie Grant, at the University of Minnesota's Carlson School of Management, received a planning grant from the Fund to design an evaluation of the initiative's outcomes, including financial impact. He also created an instrument to measure the degree of change in the culture of participating homes — the first tool of its kind to be developed and a breakthrough for the field of long-term care. Grant's full-scale evaluation, now underway, should make a major contribution to the growth of resident-centered nursing home care, especially in the for-profit sector.