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An analysis of assisted living quality award winners reveals that winning communities provided better health-related outcomes for their residents compared with communities that did not win quality awards, according to the National Center for Assisted Living.

A study conducted by Brown University analyzed Silver and Gold American Health Care Association / NCAL National Quality Award Program winners between 2017 and 2020 and compared them with assisted living communities that did not receive an award in five areas: hospitalizations, ambulatory care sensitive hospitalizations, emergency department visits, injury-related emergency department visits, and long-term nursing home transitions.

“The Quality Awards program is a rigorous process that truly improves performance in the areas of leadership, strategic planning, customer and workforce, operations and knowledge management,” NCAL Director of Quality Improvement Pam Truscott told McKnight’s Senior Living. “Participants that progress through the program must demonstrate superior quality, and as a result, these providers are the best of the best.”

Although awardees performed better than non-awardees on all outcomes, the researchers found that only emergency department use was statistically significantly lower among awardees in both 2019 (47.2%) and 2020 (50.7%) — a greater than 5% lower relative risk of emergency department use. Awardees also experienced lower risk of emergency department use during the pandemic — 43.7% for awardees versus 46% for non-awardees. 

The authors noted that previous studies found that emergency department use among assisted living residents is common and varies “substantially” among assisted living communities. The emergency department use statistics, they said, may be an outcome that is especially influenced by assisted living practices.

The AHCA/NCAL Quality Awards program is based on the Baldrige Criteria for Performance Excellence and assesses assisted living communities on several criteria. Three levels of recognition are offered — Bronze, Silver and Gold — with each level requiring a progressively more detailed demonstration of performance.

Unlike Bronze awardees at the beginning of the Quality Awards journey, Silver and Gold awardees must provide evidence of quality improvement. Silver Award winners are expected to begin to change processes and demonstrate improvement in workforce metrics.

Truscott said that the Silver and Gold award winners had better outcomes due to the “solidification of effective and efficient systems and processes.”

“Through the journey, communities gain deeper insights into their organization, leadership, strategy, customers, analysis, workforce and operations. They are then required to demonstrate performance through providing results in each of those categories,” she said. “This extensive process allows communities to gain understanding of their strengths, as well as opportunities for improvement.”

She added that the Quality Award platform helps guide communities in making informed decisions for quality improvement.

“It is the journey to performance excellence that impacts the systems, processes and the outcomes,” Truscott said. “This speaks to supporting a process that is evidence-based to improve quality in any organization, including long-term care.”

The Baldrige criteria’s focus on workforce and leadership potentially could explain the relationship between Silver and Gold Quality Award winners and emergency department use, according to the authors, who stated that nursing home literature shows that increased staffing levels relate to better resident outcomes.

Study results were based on 122,019 assisted living residents in 2019 and 128,768 assisted living residents in 2020. Approximately 3% of residents in each cohort lived in assisted living communities that were Quality Award recipients. Truscott said that the study provides a baseline for future work and confirmed that improvements in outcomes are possible, even during the COVID-19 pandemic.

NCAL also has a voluntary Quality Initiative for assisted living communities, with goals related to staff stability, customer satisfaction, hospital readmissions and the off-label use of antipsychotic medications.

The Joint Commission also launched its assisted living community accreditation in 2021 and a certification program for memory care communities earlier this year.

NCAL and other national industry associations, including Argentum, the American Seniors Housing Association and LeadingAge, announced a collaboration with the National Association for Regulatory Administration in June to develop guidance for the industry and resources for operators, regulators, policymakers and other stakeholders. The groups, working together as the Quality in Assisted Living Collaborative, first are turning their attention to the area of infection prevention and control.