Promoting Quality in Nursing Homes: The Wellspring Model

Concerns about the quality of nursing home care date back at least 30 years. According to a new Commonwealth Fund report, there is growing awareness among nursing home directors, state and federal regulators, consumer advocates, and others that staff shortages and insufficient staff training are at the root of the problem.

In Promoting Quality in Nursing Homes: The Wellspring Model, Susan Reinhard and Robyn Stone of the American Association of Homes and Services for the Aging describe one nursing home-based initiative that is striving to improve quality through model clinical practice systems and changes to the prevailing culture in nursing homes. Wellspring Innovative Solutions, Inc., an alliance of 11 nonprofit nursing homes in Wisconsin, has developed six key elements to improving nursing home quality:

• An alliance of nursing homes with top management committed to making quality of resident care a top priority.
• Shared services of a geriatric nurse practitioner (GNP), who develops training materials for and teaches two-day courses for staff from all 11 nursing homes about quality-of-care issues and applying national clinical guidelines.
• Interdisciplinary ""care resource teams"" that receive training in a specific area of care and are responsible for teaching other staff at their respective facilities.
• Involvement of all departments within the facility and networking among staff across facilities to share what works and what does not work on a practical level.
• Empowerment of all nursing home staff to make decisions that affect the quality of resident care and the work environment.
• Continuous reviews by CEOs and all staff of quality-indicator performance data on resident outcomes and environmental factors relative to other nursing homes in the Wellspring alliance.

According to Reinhard and Stone, the CEOs, directors of nursing, nursing care coordinators, and GNP of all 11 facilities meet quarterly to share and review each facility's clinical and environmental data, learn from each other's successes and failures, and share resources to support significant quality-improvement activities.


Facts and Figures

• The U.S. General Accounting Office has found that one-fourth of nursing facilities have serious deficiencies that have caused actual harm to residents or placed their health and safety at risk. Many of these homes have had repeated serious deficiencies.
• Annual turnover in nursing home staff is currently at 40 to 75 percent nationally and as high as 500 percent in certain facilities.


• In a study of several nonprofit nursing homes in Philadelphia, researchers found that the strongest predictor of lower turnover rates was the organization's management style.